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Picture Perfect: The Perclose Safety Picture
Ali Siddiqui, MD, Natalia Cavagnaro, DO, Vishal Patel, DO, Hunter Ray, MD, Kousta Foteh, MD, Eric Trestman, MD.
HCA Healthcare Kingwood, Kingwood, TX, USA.
OBJECTIVES: Percutaneous large bore arterial access has become the standard first line approach, when not contraindicated, for increasingly common procedures such as endovascular aortic repairs (EVAR). Currently, Perclose ProGlide is one device approved for large bore arterial access closure. Arteriotomies dilated for stent delivery devices with an outer diameter of 26F can be closed by two of these devices using a “preclose” technique. Previous studies have shown a 76% successful closure rate with two Perclose ProGlide devices. Undetected failure of arterial closure can lead to a delayed emergent surgical cut down and increased morbidity, specifically cases of inadvertent arterial occlusion. We propose a simply performed objective adjunctive technique aiming to reduce otherwise missed access complications and/or unplanned access related returns to the operating room named the “Perclose Safety Picture."
METHODS: We routinely use this technique in EVAR and TEVAR cases, but this is a representative case. Percutaneous large bore access was utilized for an EVAR on a 55-year-old female presenting with symptomatic abdominal aortic aneurysm. A “preclose” technique was used to close a large bore arteriotomy on the common femoral artery. The “preclose” was performed with the sequential deployment of two Perclose ProGlides at the ten and two o’clock position after arteriotomy and prior to dilation. The sutures were left untightened until the completion of the procedure. Upon completion, the sutures were tightened and cinched down over a 0.035 wire, which was left in place. Next, a micropuncture sheath with a 5F outer diameter was placed over the wire. The wire was then removed. After, an oblique projection arteriogram was performed assessing patency of the accessed vessels.
RESULTS: Our “Perclose Safety Picture” demonstrated a flow limiting dissection at the access site resulting in an immediate surgical cut down and repair of the common femoral artery with bovine patch angioplasty.
CONCLUSIONS: The “Perclose Safety Picture” is an objective adjunctive technique to the “preclose” technique that can allow operators to assess the success of their percutaneous large bore arterial access closure.
Figure 1. Perclose safety picture demonstrating a flow limiting dissection.
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