A ‘post-close’ Technique for Femoral Hemostasis After Percutaneous EVAR Using an Ultra-low-profile Endoprosthesis System

摘要

Introduction We present a ‘post-close’ technique using the Angio-Seal VIP vascular closure device (VCD) after percutaneous endovascular aneurysm repair (p-EVAR) using an ultra-low-profile (ULP) device. Technique Following percutaneous using an ULP device (here the Ovation Prime system, Trivascular, Eysins, Switzerland), contralateral femoral hemostasis is achieved by using an ‘undersized’ application of an 8F Angio-Seal VIP vascular closure device (VCD) for all punctures wherein upto 12F sheaths have been applied for access. On the ipsilateral side, following ‘double-wire’ preparation, synchronous deployment of an 8F and 6F Angio-Seal VIP VCDs achieves hemostasis. Procedural heparin is reversed as an adjunct, pressure dressings are applied and the patient kept flat for 2 hours. Discussion Double-wire VCD deployments, and ‘post-close’ techniques have not been described in the context of femoral hemostasis after p-EVAR. This technique is easy to apply and saves time (and potentially cost) used to set up ‘pre-close’ devices, as is typically used these days.