| Eligibility |
Inclusion Criteria:
1. Age = 19 years,
2. Clinically indicated for a percutaneous arterial interventional catheter-based
procedure, e.g., transcatheter aortic valve replacement/implantation (TAVR/TAVI) or
endovascular abdominal aortic aneurysm repair (EVAR), or thoracic endovascular aortic
aneurysm repair (TEVAR), or use of a circulatory assist device or extracorporeal
oxygenation using a common femoral arteriotomy created by a 12 to 22 F sheath
(arteriotomy up to 26 F),
3. Subject is willing and able to provide appropriate study-specific informed consent,
follow protocol procedures, and comply with follow-up visit requirements,
4. Females who are not pregnant or lactating and not planning to become pregnant for the
duration of the study.
Baseline Exclusion Criteria:
1. Evidence of current systemic bacterial or cutaneous infection, including groin
infection,
2. Known bleeding diathesis, definite or potential coagulopathy, platelet count <
100,000/µl or subjects on long term anticoagulants with an INR > 2 within 12 hours
prior to index procedure,
3. Significant anaemia (haemoglobin < 9 g/dL or haematocrit < 27%), within 24 hours prior
to index procedure,
4. Known type II heparin-induced thrombocytopenia,
5. Documented left ventricular ejection fraction < 20%,
6. Ipsilateral or contralateral lower extremity amputation.
7. Claudication (Rutherford category 3 or greater), documented untreated iliac or common
femoral artery diameter stenosis > 50% or previous bypass surgery/stent placement in
the common femoral artery of target leg,
8. Known existing nerve damage in the target leg,
9. Renal insufficiency (Glomerular Filtration Rate = 30 ml/min or baseline serum
creatinine > 2.5 mg/dL) or on renal replacement therapy,
10. Known allergy to any of the materials used in the PerQseal device (refer to
Instructions for Use),
11. Subject unsuitable for surgical repair of the target leg access site,
12. Subject has undergone a percutaneous procedure greater than 8 F sheath in the target
leg, within the 90-days prior to index procedure,
13. Subject has undergone a percutaneous procedure of 8 F sheath or less using an
absorbable intravascular closure device for haemostasis, in the target leg, within the
90-days prior to index procedure,
14. Subject has undergone a percutaneous procedure of 8 F sheath or less using a suture
mediated closure device or manual/mechanical pressure for haemostasis in the target
leg, within the 30-days prior to index procedure,
15. Evidence of marked tortuosity of the femoral or external iliac arteries in the target
leg, based on pre-primary procedure CT angiography,
16. Evidence of arterial diameter stenosis > 30% within 15 mm proximal or distal to
arteriotomy site based on pre-primary procedure CT angiography,
17. Evidence of anterior wall calcification of the target common femoral artery (other
than small, diffuse deposits which in the opinion of the investigator will not impede
the vascular closure procedure) within 15 mm proximal or distal to arteriotomy site
based on pre-primary procedure CT angiography,
18. Target femoral artery diameter is less than 6 mm or 7 mm, depending on whether S
(small) or L (large) PerQseal Introducer will be used for arteriotomy closure,
respectively, based on pre-primary procedure CT angiography,
19. Further planned endovascular/catheter-based procedure in the target leg in the 30-days
following the index procedure.
20. Subject is enrolled in another investigational medical device or drug study,
21. Subject has been previously enrolled in this clinical study.
22. Current COVID-19 infection (with or without symptoms), recent positive test for
COVID-19 within two weeks, or recent exposure to a person with COVID-19 infection
within two weeks.
Procedural Exclusion Criteria:
If any Procedural Exclusion Criteria listed below are met, then closure with PerQseal
device is not permitted.
23. Initial common femoral arterial access achieved with manual palpation or blind
arterial stick access, without use of an image guided approach (ultrasound or
angiography).
24. Difficult dilation during initial target femoral artery access (e.g., that damages or
kinks dilators) while step-dilating up to the large-bore device,
25. During arterial puncture, the target femoral artery suspected to have experienced a
posterior arterial wall needle puncture or underwent > one needle puncture during the
primary procedure (with a needle larger than a Micropuncture needle (> 21 gauge or >
0.819 mm diameter) )
26. Subject has a tissue tract (i.e., estimated distance from skin entry point to arterial
anterior surface at arteriotomy) expected to be greater than 8 cm.,
27. Significant blood loss requiring transfusion of blood products during primary
procedure or within 30-days prior to index procedure,
28. Activated clotting time (ACT) > 250 seconds immediately prior to sheath removal or if
ACT measurements are expected to be > 250 seconds for more than 24 hours after index
procedure,
29. Target puncture site is in a vascular graft,
30. Target arteriotomy greater than 26 F,
31. Target arteriotomy in the profunda femoris or superficial femoral artery or is in
common femoral artery, but within 15 mm proximal of the bifurcation of the superficial
femoral/ profunda femoris artery,
32. Target arteriotomy located at the level or above the inferior epigastric artery and/or
beneath or above the inguinal ligament based on bony/arterial landmarks (above femoral
head on A-P projection),
33. Subjects with an acute haematoma > 4 cm diameter, arteriovenous fistula,
pseudoaneurysm, or intraluminal thrombosis at the target access site identified
intra-procedurally,
34. Evidence of bleeding around the primary procedure sheath (VARC type1/BARC type 2 or
higher),
35. Intra-procedural angiographic evidence of arterial laceration, dissection or stenosis
within the femoral artery that would preclude use of the PerQseal device,
36. Uncontrolled hypertension (systolic blood pressure > 180 mmHg or diastolic blood
pressure > 110 mmHg) at the time of planned vascular closure,
37. Systolic blood pressure < 90 mmHg at the time of planned vascular closure.
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