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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
SAFE-SEAL: a bail-out technique for percutaneous femoral closure after failed hybrid closure
Marco Angelillis1, Leonardo Misuraca1, Paolo Calabria2
1S.D. Laboratorio di Emodinamica, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
Objectives:
Failure of the plug-based component during hybrid suture- and plug-based femoral closure may result in persistent bleeding when guidewire access is lost, leaving limited percutaneous bailout options. The authors describe a novel percutaneous bailout strategy designed to achieve hemostasis in this high-risk scenario.
Methods:
The first clinical application of the SAFE-SEAL (Suture-Assisted Femoral Emergency SEALing) technique was performed in a patient undergoing transfemoral transcatheter aortic valve implantation. Following failure of the plug-based closure component and persistent bleeding despite balloon tamponade, a bioresorbable extravascular sealant was advanced over retained suture limbs from a previously deployed suture-based closure device and positioned at the arterial wall using a knot pusher.
Results:
Complete hemostasis was achieved without additional vascular access or endovascular intervention, as confirmed angiographically. No residual bleeding or flow limitation was observed.
Conclusions:
The SAFE-SEAL technique may represent a practical and reproducible bailout option for femoral access-site bleeding after hybrid closure failure, warranting further evaluation in additional cases.
