"Double wire" angio-seal closure technique after balloon aortic valvuloplasty.

OBJECTIVES: To report the feasibility of a collagen-mediated closure device using a modified Angio-Seal closure technique for access site management following percutaneous balloon aortic valvuloplasty (BAV).

BACKGROUND: With the advent of percutaneous aortic valve replacement therapies, there has been a resurgence of interest in BAV procedures. Vascular complications, including bleeding, are a common source of morbidity post procedure as a result of the requirement for large bore femoral artery access. The use of vascular closure devices may reduce bleeding complications.

METHODS: We describe a new technique for vascular closure in this setting. At the conclusion of the valvuloplasty procedure, two 0.035'' wires are inserted through the femoral artery sheath. A conventional collagen-mediated closure device (8F Angio-Seal) is deployed over the first wire and along side the second wire. If immediate hemostasis is not achieved, a second device is loaded onto the second wire and deployed to achieve hemostasis.

RESULTS: Percutaneous BAV was performed in 21 patients. Hemostasis was successfully achieved in all patients with either a single 8F Angio-Seal closure device (18 patients) or after placement of a second device (three patients).

CONCLUSIONS: The modified "Double Wire" Angio-Seal technique is a feasible method for hemostasis following percutaneous BAV.