Percutaneous Management of Vessel Occlusion Caused by Suture-Based Closure Devices: A Case Series and Benchtop Model

Large-bore arterial access (LBAA) closure for percutaneous interventional procedures is often achieved using suture-based vascular closure devices (VCDs), most commonly Perclose ProGlide (Abbott Vascular, Santa Clara, CA). Although the rate of vascular occlusion due to suture-based VCDs is rare, there is no widely accepted percutaneous bailout treatment for this device-related complication.

This investigation sought to evaluate the percutaneous treatment of suture-based VCD-mediated closure in vivo and explain its mechanism with an ex vivo benchtop model.

This retrospective cohort study focused on patients who underwent LBAA closure complicated by vascular occlusion related to the Perclose VCD. These were managed through percutaneous endovascular interventions (PEI), in which the identified occlusions were treated using a peripheral cutting balloon. Additionally, a benchtop model utilizing silicone tubing was developed to simulate the occlusion mechanism caused by the Perclose VCD and to compare the use of non-compliant versus cutting balloons in this context.

A 6 mm cutting balloon successfully cut the monofilament polypropylene at 3 atmospheres (ATM), whereas a 5 mm non-compliant balloon failed, even at a burst pressure of 24 ATM. In this patient cohort, seven patients were found to have common femoral artery (CFA) occlusion following the tightening of the previously deployed Perclose VCD. The median age was 87 years (interquartile range: 80-87), 71% were female, and had significant cardiovascular risk factors. All patients were diagnosed with CFA occlusion at the end of the transcatheter aortic valve replacement procedure during aortoiliac angiography, following vascular closure. PEI was performed using a combined cutting balloon and balloon angioplasty approach across the entire patient cohort with complete revascularization, minimal residual stenosis, no severe complications, no covered stents required, and no reported conversions to surgery. Long-term follow-up in six patients showed no reinterventions required or related mortalities.

Based on the findings from our ex vivo model and clinical experience, peripheral cutting balloon angioplasty should be considered for the management of vessel occlusion caused by suture-based VCD.