Читать книгу Interventional Cardiology - Группа авторов - Страница 57

The Perclose device is a suture‐mediated system which has undergone a steady evolution which included the Techstar device, Closer S 6 Fr, and the current ProGlide 6 Fr system. It incorporates two needles in the proximal compartment of the device and a catheter that houses the suture (Figure 2.5). The working sheath is exchanged over a wire for the Perclose device. The device is advanced until return of pulsatile blood in the locator, indicating appropriate intravascular placement. A lever is pulled to open the “feet,” and the device is withdrawn until resistance is felt, indicating apposition of the foot processes and suture catch plates against the inner vessel wall. A plunger is depressed, forcing the needles through the outer vessel wall into the suture catch plates. The catch plates are attached to the ends of the suture. Retraction of the plunger withdraws the needles and the attached sutures through the skin. With the current ProGlide system, the device incorporates a non‐absorbable polypropylene monofilament with pre‐tied knot that is tightened, and the vascular access site closed using a pusher device. One significant advantage of the Perclose system is to maintain access to the vessel during deploying the device by using the guidewire before withdrawing the device. Therefore, the wire can be reintroduced via the device after the needle and suture deployment, and the wire removed after confirmation of adequate hemostasis. This feature is unique among the closure approaches. In most series, the device is successfully deployed in 89–100%, with hemostasis success seen in 86–99%. The Prostar device is a Perclose‐based suture mediated device, which allows for closure of larger arteriotomy. It comes in 8 or 10 Fr and can incorporate one or two sutures (associated with two or four needles, respectively). The Prostar device have been extensively used in the early TAVR era for arteriotomy suture‐mediated closure. However, in the more recent experience the use of two ProGlide devices inserted forming a St Andrew’s cross compared with Prostar was associated with significantly lower rates of closure device failure, minor and major bleedings, lower major vascular complications and possibly also lower in‐hospital mortality rates [27, 28].

Figure 2.5 The Perclose ProGlide device is used to deliver sutures through the puncture to close the arteriotomy site. The small insets of the upper left of the figure show feet that are opened inside the artery, and the mechanism by which needles are driven from the handle of the device into the feet to capture the sutures. The sutures are then withdrawn using the needles, and a pre‐tied knot is pushed through the skin to the top of the arteriotomy site on the outside of the artery.