Video Demonstration of the Single-Access Dry-Closure Technique

The use of large-bore sheaths has risen exponentially in the last decade, partly due to the growth of structural heart interventions and various mechanical circulatory support options. Meanwhile, the interventional community has gradually shifted from an open surgical to endovascular closure. However, vascular access complications and bleeding still remain a significant risk. Various techniques involving an additional access site have been described to allow for endovascular bailout of potential complications. However, these by themselves create an additional burden to procedural morbidity. Furthermore, the weight of additional procedural time, contrast, radiation, and the need for advanced peripheral endovascular skills constitute considerable downsides to the “second arterial access” strategy. We propose an alternative strategy, the “single-access dry-closure” technique, which provides vascular access control without the additional burden and risk of a second arterial access. This involves the use of low-pressure iliac artery occlusive angioplasty, delivered through the ipsilateral sheath during the endovascular closure. This supplemental video illustrates the key steps of this technique.

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