SAFE-SEAL: a bail-out technique for percutaneous femoral closure after failed hybrid closure.

OBJECTIVES

Failure of the plug-based component during hybrid suture- and plug-based femoral closure may result in persistent bleeding when guidewire access is lost, leaving limited percutaneous bailout options. The authors describe a novel percutaneous bailout strategy designed to achieve hemostasis in this high-risk scenario.

METHODS

The first clinical application of the SAFE-SEAL (Suture-Assisted Femoral Emergency SEALing) technique was performed in a patient undergoing transfemoral transcatheter aortic valve implantation. Following failure of the plug-based closure component and persistent bleeding despite balloon tamponade, a bioresorbable extravascular sealant was advanced over retained suture limbs from a previously deployed suture-based closure device and positioned at the arterial wall using a knot pusher.

RESULTS

Complete hemostasis was achieved without additional vascular access or endovascular intervention, as confirmed angiographically. No residual bleeding or flow limitation was observed.

CONCLUSIONS

The SAFE-SEAL technique may represent a practical and reproducible bailout option for femoral access-site bleeding after hybrid closure failure, warranting further evaluation in additional cases.