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

Agostino Spano'; Ole De Backer; Ignacio J Amat-Santos; Marouane Boukhris; Adrien Jossart; Jacques Auslender; Giuseppe Colletti; Mihai Cocoi; Claudiu Ungureanu

doi:10.1002/ccd.70285

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

Agostino Spano'^*, Ole De Backer, Ignacio J Amat-Santos, Marouane Boukhris, Adrien Jossart, Jacques Auslender, Giuseppe Colletti, Mihai Cocoi, Claudiu Ungureanu

^*Corresponding author for this work

Department of Cardiology

Abstract

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.

Original language	English
Journal	Catheterization and Cardiovascular Interventions
Volume	107
Issue number	1
Pages (from-to)	61-69
Number of pages	9
ISSN	1522-1946
DOIs	https://doi.org/10.1002/ccd.70285
Publication status	Published - Jan 2026

Keywords

Aged
Aged, 80 and over
Aortic Valve Stenosis/diagnostic imaging
Catheterization, Peripheral/adverse effects
Female
Femoral Artery/diagnostic imaging
Hemorrhage/prevention & control
Hemostatic Techniques/instrumentation
Humans
Male
Peripheral Arterial Disease/diagnostic imaging
Punctures
Suture Techniques/instrumentation
Transcatheter Aortic Valve Replacement/adverse effects
Treatment Outcome
Vascular Calcification/diagnostic imaging
Vascular Closure Devices

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Spano', A., De Backer, O., Amat-Santos, I. J., Boukhris, M., Jossart, A., Auslender, J., Colletti, G., Cocoi, M., & Ungureanu, C. (2026). Angioplasty-Assisted, Suture-Mediated Vascular Closure Enabling Percutaneous Transfemoral TAVR in Case of a Diseased Puncture Site. The FEM-PREP Technique. Catheterization and Cardiovascular Interventions, 107(1), 61-69. https://doi.org/10.1002/ccd.70285

Angioplasty-Assisted, Suture-Mediated Vascular Closure Enabling Percutaneous Transfemoral TAVR in Case of a Diseased Puncture Site. The FEM-PREP Technique. / Spano', Agostino; De Backer, Ole; Amat-Santos, Ignacio J et al.
In: Catheterization and Cardiovascular Interventions, Vol. 107, No. 1, 01.2026, p. 61-69.

Research output: Contribution to journal › Journal article › Research › peer-review

Spano', A, De Backer, O, Amat-Santos, IJ, Boukhris, M, Jossart, A, Auslender, J, Colletti, G, Cocoi, M & Ungureanu, C 2026, 'Angioplasty-Assisted, Suture-Mediated Vascular Closure Enabling Percutaneous Transfemoral TAVR in Case of a Diseased Puncture Site. The FEM-PREP Technique', Catheterization and Cardiovascular Interventions, vol. 107, no. 1, pp. 61-69. https://doi.org/10.1002/ccd.70285

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abstract = "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.",

keywords = "Aged, Aged, 80 and over, Aortic Valve Stenosis/diagnostic imaging, Catheterization, Peripheral/adverse effects, Female, Femoral Artery/diagnostic imaging, Hemorrhage/prevention \& control, Hemostatic Techniques/instrumentation, Humans, Male, Peripheral Arterial Disease/diagnostic imaging, Punctures, Suture Techniques/instrumentation, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, Vascular Calcification/diagnostic imaging, Vascular Closure Devices",

author = "Agostino Spano' and \{De Backer\}, Ole and Amat-Santos, \{Ignacio J\} and Marouane Boukhris and Adrien Jossart and Jacques Auslender and Giuseppe Colletti and Mihai Cocoi and Claudiu Ungureanu",

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T1 - Angioplasty-Assisted, Suture-Mediated Vascular Closure Enabling Percutaneous Transfemoral TAVR in Case of a Diseased Puncture Site. The FEM-PREP Technique

AU - Spano', Agostino

AU - De Backer, Ole

AU - Amat-Santos, Ignacio J

AU - Boukhris, Marouane

AU - Jossart, Adrien

AU - Auslender, Jacques

AU - Colletti, Giuseppe

AU - Cocoi, Mihai

AU - Ungureanu, Claudiu

PY - 2026/1

Y1 - 2026/1

N2 - 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.

AB - 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.

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KW - Aged, 80 and over

KW - Aortic Valve Stenosis/diagnostic imaging

KW - Catheterization, Peripheral/adverse effects

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KW - Hemorrhage/prevention & control

KW - Hemostatic Techniques/instrumentation

KW - Humans

KW - Male

KW - Peripheral Arterial Disease/diagnostic imaging

KW - Punctures

KW - Suture Techniques/instrumentation

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

KW - Vascular Calcification/diagnostic imaging

KW - Vascular Closure Devices

UR - https://www.scopus.com/pages/publications/105020769248

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DO - 10.1002/ccd.70285

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SN - 1522-1946

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JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

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ER -

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

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Keywords

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