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Using Arterial Recoil for Large Bore Access Closure After Impella Assist Device Removal.

Khawaja M Talha1, John G Winscott2, Vishal Patel1

  • 1From the Department of Medicine, University of Mississippi Medical Center, Jackson, MS.

Critical Pathways in Cardiology
|November 9, 2023
PubMed
Summary

A new method for closing large bore arterial access after Impella device removal proved safe and effective. This technique, using arterial recoil, resulted in successful closure without complications in all patients studied.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Access Management

Background:

  • The use of Impella assist devices for high-risk percutaneous coronary interventions and cardiogenic shock has risen, necessitating large bore arterial access (LBA).
  • Closure of LBA after Impella removal presents significant complication risks, driving the need for improved techniques.

Purpose of the Study:

  • To describe the safety and efficacy of a novel method for LBA closure utilizing arterial recoil post-Impella removal.
  • To evaluate outcomes including closure success and access site complications associated with this technique.

Main Methods:

  • A retrospective review of electronic medical records from July 2018 to June 2022.
  • The novel method involves controlled downsizing of the arterial sheath to 6 Fr catheters with intermittent compression to facilitate hemostasis via arterial recoil.
  • Data collected included patient demographics, closure success rates, and immediate/delayed bleeding and access site complications.

Main Results:

  • Twenty out of 103 patients (19%) with Impella placement underwent LBA closure using the novel method.
  • Successful LBA closure was achieved in all patients (100%) with no immediate or delayed bleeding complications.
  • Five patients (25%) died during hospitalization, with causes unrelated to the Impella removal or LBA closure procedure.

Conclusions:

  • The described novel method for LBA closure following Impella removal is safe and effective.
  • The technique demonstrated a high success rate and absence of vascular complications in this patient cohort.
  • Further prospective studies are recommended to confirm the comparative efficacy of this arterial recoil method.