Pledget-assisted hemostasis to fix residual access-site bleedings after double pre-closure technique

Figure 1 Angiography before and after pledget-assisted hemostasis. A: Residual bleeding at the transcatheter-aortic-valve-replacement access site (white arrow) after double ProGlide preclosure; B: Absence of residual bleeding (white arrow) after pledget assisted hemostasis.

Figure 2 Steps of pledget-assisted hemostasis. The technique is shown as practiced on a white drape in order to show the steps in the absence of blood. A: Double ProGlide suture after cutting one monofilament from each device and pledget (red arrow); B: Insertion of two cannulas through the pledget (colored by iodine solution to facilitate recognition); C: Steel needles removal from the cannulas; D: Insertion of ProGlide monofilaments through the cannulas; E: Cannulas removal leaving Proglide monofilaments inserted through the pledget; F: Realization of one of two knots; G: Pledget fixation on the artery wall tightening the knots; H: Cut of residual Proglide threads; I: Final configuration achieved with pledged tightened over the two ProGlide’s sutures.