Angioplasty-Assisted, Suture-Mediated Vascular Closure Enabling Percutaneous Transfemoral TAVR in Case of a Diseased Puncture Site. The FEM-PREP Technique.

BACKGROUND

Suture-mediated closure using the ProGlide system can fail during transfemoral transcatheter aortic valve implantation (TAVR) in patients with heavily calcified femoral arteries, complicating vascular access management.

METHODS

We describe a case series of three TAVR procedure in which ProGlide pre-closure failed due to calcified plaques impairing footplate apposition, despite accurate ultrasound-guided puncture. Then, a bailout strategy involving femoral angioplasty via a secondary vascular access, the Fem-PREP (Femoral Preparation for Preclosure) technique, was employed to improve vessel compliance and luminal diameter.

RESULTS

The Fem-PREP technique provided minimal space required for adequate ProGlide footplate mobility, reducing plaque interference and enabling successful suture deployment in all cases without vascular complications.

CONCLUSIONS

Targeted femoral angioplasty using Fem-PREP may overcome one of the key mechanical limitation associated with pre-closure failure in calcified femoral arteries, offering a simple and effective adjunctive technique in selected TAVR patients.