Division of Cardiovascular Diseases, Lankenau Medical Center, Lankenau Institute of Medical Research, Wynnewood, PA, USA.
Division of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Institute of Medical Research, Wynnewood, PA, USA.
J Endovasc Ther. 2023 Dec;30(6):885-891. doi: 10.1177/15266028221105187. Epub 2022 Jun 29.
Vascular complications are a cause of increased morbidity and mortality when performing percutaneous procedures requiring large-bore arterial access. MANTA vascular closure device (VCD) is currently the only large-bore VCD using an intraluminal foot plate and an extraluminal collagen plug. The traditional depth locator approach might be compromised in; emergent cases without the required measurements, cases of hematoma formation, or other patient, procedure, or operator-specific variables. Furthermore, this technique can be used for postclosure in cases without the required measurement of depth. We describe vascular outcomes using fluoroscopy (fluoroscopic DOT technique) rather than traditional depth locator approach for vascular closure with the MANTA VCD.
Fifty patients who underwent transcatheter aortic valve implantation (TAVI) were retrospectively analyzed using fluoroscopic DOT technique with 18F MANTA VCD between May and August 2021. All patients >18 years of age who qualified for transfemoral TAVI were included. Access was obtained with ultrasound guidance with vessel diameter of at least 6 mm and free from anterior vessel wall calcification. Patient related factors and primary outcomes of access site bleeding and acute flow-limited limb ischemia requiring intervention were prospectively analyzed. Furthermore, 1 patient who failed hemostasis with suture-mediated VCD had successful hemostasis with fluoroscopic DOT technique as dry postclosure after balloon aortic valvuloplasty.
In total, 50 patients were analyzed with a mean age of 81 years and majority were male (56%). Majority had comorbidities of hypertension (88%) and hyperlipidemia (94%), 24% had peripheral arterial disease, 38% coronary artery disease, and 58% were former smokers. Importantly, 40% were obese with an average body mass index (BMI) of 29 kg/m. There were no bleeding or ischemic limb complications post MANTA VCD deployment using the fluoroscopic DOT technique. Furthermore, none of the patients required peripheral intervention from index procedure to 1 month post verified during their 1-month post TAVR follow-up.
Fluoroscopic DOT technique using the MANTA VCD is highly reproducible and allows hemostasis in a predictable manner for procedures requiring large-bore arterial access in the absence of MANTA depth measurement.
在需要大口径动脉入路的经皮操作中，血管并发症是增加发病率和死亡率的一个原因。Manta 血管闭合装置（VCD）是目前唯一一种使用腔内足板和腔外胶原塞的大口径 VCD。传统的深度定位器方法可能会受到影响; 在没有所需测量值的紧急情况下、血肿形成的情况下，或其他患者、手术或操作人员特定变量的情况下。此外，在没有所需深度测量值的情况下，这种技术也可用于闭合后。我们使用透视（透视 DOT 技术）而不是传统的深度定位器方法来描述使用 Manta VCD 进行血管闭合后的血管结果。
2021 年 5 月至 8 月，我们对 50 例接受经导管主动脉瓣置换术（TAVI）的患者进行了回顾性分析，这些患者使用 18F Manta VCD 进行透视 DOT 技术。所有年龄>18 岁且符合经股 TAVI 标准的患者均纳入研究。使用超声引导进行入路，血管直径至少为 6 毫米，且无前方血管壁钙化。前瞻性分析了患者相关因素和主要结局，包括血管入路出血和需要介入治疗的急性血流受限肢体缺血。此外，1 例缝合介导的 VCD 止血失败的患者，在球囊主动脉瓣成形术后，使用透视 DOT 技术成功止血，达到干燥闭合。
共分析了 50 例患者，平均年龄为 81 岁，多数为男性（56%）。多数患者合并高血压（88%）和高脂血症（94%），24%有外周动脉疾病，38%有冠心病，58%为曾经吸烟者。重要的是，40%的患者肥胖，平均体重指数（BMI）为 29kg/m。使用透视 DOT 技术，Manta VCD 植入后无出血或缺血肢体并发症。此外，在 TAVR 后 1 个月的随访中，没有患者需要从指数手术到 1 个月后进行外周介入治疗。
使用 Manta VCD 的透视 DOT 技术具有高度可重复性，并允许在没有 Manta 深度测量的情况下，以可预测的方式对需要大口径动脉入路的操作进行止血。
