Large Bore Access for the Interventional Cardiologist-Closure

Video Transcription

Video Summary

The panel discussion focuses on large-bore vascular access (greater than 8 French) used in interventional cardiology, emphasizing closure techniques to minimize complications such as bleeding and vascular injury. Large sheaths pose significant risks with vascular complications ranging from 6% to 60%. Historically, manual compression was the standard for hemostasis, but closure devices have become preferred, primarily suture-based (e.g., Perclose) and collagen- or plug-based devices (e.g., Manta and AngioSeal).<br /><br />Manta functions similarly to AngioSeal but has a larger footplate to accommodate larger arteriotomy sites and requires precise pre-measurement of arteriotomy depth before deployment. If pre-closure is not performed, post-closure techniques with Manta or multiple sutures can be used, often aided by fluoroscopy and contralateral access to confirm vessel patency and manage complications via balloon tamponade or covered stents.<br /><br />Venous closure, while easier, also benefits from closure devices and suture techniques, with practices varying based on sheath size and patient anatomy. Pre-closure with two sutures is common for larger venous access, sometimes supplemented by figure-of-eight sutures.<br /><br />Management of mechanical support device removal (e.g., Impella) depends on whether pre-closure was done. If not feasible, vascular surgery may be needed, or post-closure with devices like Manta combined with balloon tamponade. Infection risks remain low with prophylactic antibiotics and sterile techniques.<br /><br />Panelists highlight the importance of operator experience, vessel calcification assessment, and bailout strategies including ballooning or surgical repair when closures fail. The session concludes that closure device choice depends on anatomy, calcification, operator preference, and available tools, with ongoing advancements improving safety and efficacy in large-bore interventions.

Keywords

large-bore vascular access

interventional cardiology

closure devices

Manta device

arteriotomy depth measurement

vascular complications

mechanical support device removal