Vascular closure devices: the jury is still out

Abstract

Transcatheter aortic valve implantation (TAVI) is an established treatment for elderly patients with severe symptomatic aortic stenosis. Currently, most procedures are performed through transfemoral transcatheter aortic valve implantation (TF-TAVI) under conscious sedation via vascular access with safe and effective closure.1 Nonetheless, large-bore transcatheter arterial accesses are inherently associated with a higher risk of vascular and hemorrhagic complications.2 The use of vascular closure devices (VCDs) in endovascular procedures has grown exponentially. Their emergence has reduced time to hemostasis, facilitated early ambulation and discharge, and reduced hospitalization costs.2-4 However, failed VCDs are not an uncommon finding (1%-8%), and vascular and hemorrhagic complications—most commonly found at the access site—can sometimes determine procedural success or failure.5,6 Vascular complications significantly contribute to clinical outcomes in the short- and long-term, including length of stay, rehospitalizations, need for blood transfusions, and all-cause mortality.2,4 Therefore, successful arterial access and closure is critical in TAVI.2,7,8 CURRENT DEVICES The most widely used VCDs for large-bore arteriotomy closure are the suture-mediated closure system, Perclose ProGlide system (Abbott Vascular, United States), and the most recent plug-based MANTA vascular closure device (Teleflex/Essential Medical, United States). The failure mechanisms associated with the Perclose ProGlide device include suture-related malfunction, unsuccessful deployment, and incomplete vessel wall apposition. Potential errors associated with...