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Updated: Jan 28, 2026

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Large-bore Vascular Closure: New Devices and Techniques.

Maarten P van Wiechen1, Jurgen M Ligthart1, Nicolas M Van Mieghem1

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Interventional Cardiology (London, England)
|March 13, 2019
PubMed
Summary

Large-bore vascular access for endovascular procedures like TAVI and endovascular aneurysm repair is increasing. Safe large-bore access requires meticulous site management and reliable closure devices to prevent bleeding complications.

Keywords:
Transcatheter aortic valve implantationendovascular aneurysm repairmechanically circulatory supportvascular accessvascular closure device

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Area of Science:

  • Interventional Cardiology
  • Vascular Surgery
  • Medical Device Technology

Background:

  • Minimally invasive endovascular procedures, including endovascular aneurysm repair (EVAR), transcatheter aortic valve implantation (TAVI), and percutaneous mechanical circulatory support (PMCS), are increasingly preferred over traditional surgery.
  • These advanced interventions necessitate large-bore arterial access, typically via the femoral artery.
  • A significant challenge associated with large-bore access is the risk of clinically relevant vascular bleeding complications.

Purpose of the Study:

  • To review current strategies for achieving optimal femoral artery access in patients undergoing large-bore endovascular procedures.
  • To provide an overview of contemporary percutaneous closure technologies used to manage access sites.
  • To emphasize the importance of meticulous access site management for the safe and effective implementation of these advanced techniques.

Main Methods:

  • Review of current literature and clinical practices regarding femoral artery access techniques.
  • Analysis of available percutaneous closure devices and their mechanisms of action.
  • Discussion of best practices for puncture technique and post-procedural site management.

Main Results:

  • Various techniques exist for achieving large-bore femoral access, each with specific advantages and potential risks.
  • A range of percutaneous closure devices are available, offering different methods for achieving hemostasis.
  • Effective management of the access site, combining precise puncture and reliable closure, is critical for minimizing vascular complications.

Conclusions:

  • Meticulous attention to femoral access technique and the judicious selection of percutaneous closure devices are paramount for the safe expansion of large-bore endovascular interventions.
  • Continued innovation in closure technology aims to further improve safety and efficacy, supporting the growing adoption of these life-saving procedures.