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Angiographic Analysis of Vascular Integrity After Percutaneous Closure Using Prostar XL Device During Transcatheter
Fabien Lareyre1,2, Juliette Raffort2, Carine Dommerc1
11 Cardiothoracic Centre of Monaco, Monaco, France.
Insights
Systematic angiography after Prostar XL device closure for transcatheter aortic valve implantation (TAVI) identified vascular complications. This approach allows for endovascular treatment and a low rate of open surgery conversion.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Interventional Cardiology
Background:
- Percutaneous closure devices are standard for hemostasis in endovascular procedures like TAVI.
- The Prostar XL device is frequently used for femoral arterial closure.
Purpose of the Study:
- To assess the quality and safety of Prostar XL device closure for femoral arteries during TAVI.
- To evaluate the utility of routine intraprocedural angiography for detecting complications.
Main Methods:
- Prospective registration of 217 patients undergoing TAVI with percutaneous transfemoral access.
- Systematic intraprocedural angiography to evaluate Prostar XL device closure.
- Classification of complications including stenosis, bleeding, dissection, suture failure, and misplacement.
Main Results:
- 10.6% of patients experienced closure-related complications.
- Stenosis (6.1%) and persistent bleeding (2.8%) were the most common complications.
- One case of suture failure and one device misplacement required surgical intervention.
Conclusions:
- Intraprocedural angiography effectively detects vascular complications after Prostar XL closure.
- Endovascular treatment is feasible for most detected complications.
- This strategy is associated with a low conversion rate to open surgery.
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.
