International Society For Minimally Invasive Cardiothoracic Surgery

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A Novel Approach To Total Percutaneous Closure Of Large Bore Arteriotomy After An Emergent Percutaneous Procedure
Mark Joseph.
Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.

Objective: Percutaneous access is rapidly expanding to becoming standard of care for large bore arterial catheters and cannulas. With the advent of closure devices that mimic surgical closure, the need for a surgical cutdown has decreased dramatically in the elective setting. However, in the case of emergent percutaneous access, a cutdown is usually required for closure of these access sites.
Methods: We describe a novel technique for closure of arterial access sites that can be used in instances where emergent percutaneous access is performed without the need of a surgical cutdown and repair. This technique maintains wire access and allows for a total percutaneous closure of a large bore arteriotomy in the event a "preclose" technique is unable to be performed due to the emergent need or urgency of the procedure.
Results: A total of 8 patients underwent closure of large bore arteriotomy sites either after a femoral based percutaneous ventricular assist device or emergent life support (ECLS). The arteriotomy ranged in size from that of a 14Fr to a 21Fr catheter or cannula. All patients had adequate hemostasis without the need of additional percutaneous or surgical closure techniques. There were no vascular complications with good distal pulses documented post conclusion of the procedure.
Conclusions: Emergent percutaneous access does not mandate a surgical cutdown and repair for closure. A totally percutaneous closure can still be a viable alternative than surgical cutdown thus avoiding the risks of poor wound healing, seroma or significant pain.

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