Angiographic Analysis of Vascular Integrity After Percutaneous Closure Using Prostar XL Device During Transcatheter Aortic Valve Implantation

Introduction: Percutaneous closure devices are commonly used to achieve hemostasis during endovascular procedures including transcatheter aortic valve implantation (TAVI). The aim of our study was to investigate the quality of the percutaneous femoral arterial closure by Prostar XL device using a sy...

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Bibliographic Details
Published in:Vascular and endovascular surgery 2017-07, Vol.51 (5), p.282-287
Main Authors: Lareyre, Fabien, Raffort, Juliette, Dommerc, Carine, Benhammamia, Mohamed, Bourlon, François, Habib, Yacoub, Mialhe, Claude
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Valve Stenosis - diagnostic imaging
Aortic Valve Stenosis - surgery
Computed Tomography Angiography
Female
Femoral Artery - diagnostic imaging
Heart Valve Prosthesis
Hemostatic Techniques - instrumentation
Humans
Male
Postoperative Hemorrhage - etiology
Postoperative Hemorrhage - prevention & control
Predictive Value of Tests
Prospective Studies
Prosthesis Design
Punctures
Retrospective Studies
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - instrumentation
Treatment Outcome
Vascular Closure Devices
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Summary:Introduction: Percutaneous closure devices are commonly used to achieve hemostasis during endovascular procedures including transcatheter aortic valve implantation (TAVI). The aim of our study was to investigate the quality of the percutaneous femoral arterial closure by Prostar XL device using a systematic peroperative angiographic control at the end of TAVI procedure. Materials and Methods: Two hundred seventeen consecutive patients (mean age: 84 [6.5]; 112 women and 105 men) undergoing TAVI with percutaneous transfemoral access were prospectively registered in our center. Preoperative computed tomography scan was performed, and mean femoral vessel diameter was 7.9 (0.9) mm. At the end of TAVI intervention, the hemostasis was systematically achieved using the percutaneous closure device Prostar XL, without selection of patients based on anatomical criteria. An angiography with front and oblique views was performed to evaluate the quality and the safety of the closure device. Success of the percutaneous closure was defined as the absence of hemorrhage and the restitution of the arterial anatomy. Complications related to the percutaneous closure were classified as stenosis, dissection at the puncture site, suture failure, misplacement, or persistent bleeding. Results: Twenty-three (10.6%) patients had complications related to arterial percutaneous closure—14 (60.8%) stenosis, 6 (26.1%) persistent bleeding, and 1 (4.3%) dissection. These lesions were accessible to endovascular treatment via a crossover procedure. One (4.3%) suture failure and 1 (4.3%) misplacement of the device, with a puncture site created above the femoral arch, were reported. The patient developed a retroperitoneal hematoma postoperatively and required transfusion of 2 units of red blood cells associated with a cutdown to remove hematoma and to repair the common femoral artery. Conclusion: Angiography after arterial percutaneous closure using Prostar XL device during TAVI allows detection and endovascular treatment of vascular complications and is associated with low rate of conversion to open surgery.
ISSN:1538-5744
1938-9116
DOI:10.1177/1538574417705285