Called to help with a case. Morbidly obese patient. Very angulated arteriotomy entry point. Perclose “stuck” and will not come out. Ongoing bleeding around Perclose! How would you manage? #radialfirst #unsafefemoral

I think we have here is aggressive push of angio seal after two semi-failed perclose after #tavr . That’s a lot of collagen 1 cm above puncture site. Around the horn to trap and seal with stent graft. Always learning .

. When 2 perclose devices lead to a significant stenosis of the CFA, cancelling one before locking the knot may mitigate the need to go for PTA or further interventions

“Minimalistic” alternative access for TAVR - fully perc left subclavian 26 mm S3 with bilateral radial access; 7Fr ipsilateral radial for dry sheath exchange and closure using hemostatic balloon (IVUS sized); 2 pre-deployed perclose; pace over Confida wire; conscious sedation.

88y,o,f, 13th PO d #TAVI , #PTE , anticoagulated (apixaban), #pseudoaneurysm (4.0 cm) LCFA below the inguinal ligament. #Perclose was used for RCFA closure (16Fr) and LCFA compression (7Fr). Hb: 8.5. WWYD? 1. #Thrombin 2. #Coils 3. #Covered #stent 4.Open #surgery ?

Steps for Percutaneous left Axillary Access #PercAx for #TAVR - Planning is key, CT scan to size the artery & prepare balloon/covered stent for bailout. J wire from groin.
Use US guidance
Micro-puncture technique, fluoroscopy & angiogram via 4 Fr --> double PerClose then TAVR

For those unaware, please ask your cardiac or vasc surg colleagues to show you how to use this (Rumel vascular hemostatic device). Will function as a temporary external seal over your 2 cinched (but not cut) perclose sutures. You can avoid angioseal and improve hemostasis.

67♂️with severe MR. Case (mitraclip)started smoothly with RFV access(not US-guided)then single pre-perclose in the RFV. Successfully mitraclip deployment with👍 result . At the end of the procedure perclose sealed the RFV but arterial bleeding started.. Cross-over injection👇1/3

First Chicago implant of Abiomed #Impella RP Flex: Severe RV shock in pt w/prior LVAD - remarkably flexible (as advertised), supportive (3.1-3.3L/min at P6) & conducive to rapid deployment with venous Perclose x 2 before & figure 8 stitch after. #CardioTwitter #UChicagoCathLab

Multiple failed #Perclose post Impella. Heavily calcified CFA! Two 8F #Angioseals did the trick! This is how to do it
- Place two wires through the 14F sheath
- Remove the sheath and place 8F sheath on one wire and Angioseal using the other
- Then Angioseal using the second…

#Safefemoral Carotid Stenting, use US for access, micro-puncture technique, femoral angio prior to committing to 6 Fr sheath & perclose, EPD(filter) is a MUST, stent with safe healthy segment in CCA .. Expedited discharge if clinically stable.

When you see this after TAVR, what is your strategy?68 y/o with lupus, groin closed with perclose?

Love doing #EVAR for enlarging AAA with iliac aneurysm.
Minimally invasive repair with Manta closure and double Perclose using Gore device, one day length of stay.

Returning to Twitter with a very interesting case. ViV TAVR through left subclavian artery. Perclose at the end.

1 Perclose + 1 Angioseal 8F + some protamine + few minutes of manual hold > great combo for large bore access hemostasis 👍🏻

How to break a perclose device

Wrap the blue suture around your finger and with the suture trimmer down on the top of the knot (in the blue suture) pull the white suture until it snaps. Abbott Cardiovascular Saroj Neupane Babar Basir Evandro Martins F. MD

How to check for bleeding after #Impella single-access PCI: pull out 14F sheath, advance 4F sheath, push Perclose knots 🪢 onto 4F sheath, do angiogram👇. I learnt it from Duane Pinto MD MPH. Quite useful when you can’t do final angiogram from radial (tall pts, tortuosity, etc).

How do you deal with the perclose shut down after TAVR? @Mustapja Fadi Saab Ethan Korngold, MD Antonio Frangieh, MD, MPH, FACC, FSCAI Jay Mathews MD, MS, FACC, FSCAI 👊🏾👍🏾BT Fisher Sr., MD @ajaykirtane Nicholas Hanna, MD, FACC Joseph Walsh Mauricio G. Cohen MD David J. Cohen, MD, MSc raghava gollapudi Hashim Khan, MD Abdallah Bitar MD PhD Justin Cox

#cardiotwitter from archives
This angio done post #Impella removal with 2 perclose used. Pt had no distal pulse & mild leg pain.
What would you do?!
Mamas A. Mamas Gregg W. Stone MD jedicath աǟզǟʀ.ǟɦʍɛɖ د. نبيل إسماعيل Raja Hatem Evandro Martins F. MD @lorenzo2509 @ajaykirtane Hung Q. Ly, MD, SM

A fantastic step-by-step tutorial on how to deploy the #Perclose Proglide courtesy of Ajar Kochar SCAI Now #SCAIFIT18