Large Vessel Closure: Where Do We Go From Here?

A Tuesday session on large vessel closure was presented by Dr. Zvonomir Kracjer of the Texas Heart Institute and Luke’s Medical Center in Houston, Texas. Dr. Kracjer began with a review of large vessel closure devices (VCDs) approved for clinical use in the United States, including Prostar (Abbott), ProGlide (Abbott), and Manta (Teleflex). He presented information on each VCD, including their technical success.

He then reviewed investigational large VCDs, with in-depth reviews of Cross-Seal (Terumo), which is not approved for clinical use in the United States; PerQseal (Vivasure Medical), which is not available in the United States; the InClosure scaffold cover and suture (InSeal Medical); and the Arterica large-bore VCD, which has completed a first-in-man clinical trial with encouraging preliminary results. He presented the features of each along with the technical success rate of the PerQseal device (96%).

When discussing how clinicians can decide which of these devices could be the best for which indication, Dr. Kracjer noted that no studies exist comparing different large-bore VCDs in the presence of obesity, access calcium, atherosclerotic disease, small vessel diameter, and vessel tortuosity. Technical success of large-bore VCDs varies between devices from 83% and 97.7%, he said, and major vascular complications vary from 2% to 14% for different VCDs.

Dr. Kracjer concluded that selection and imaging are essential to avoid vascular complications, and the next decade will see an increased use of large-bore VCDs due to the popularity of percutaneous approaches for endovascular aneurysm repair, thoracic endovascular aortic repair, and transcatheter aortic valve replacement.