Innovative Single-Access Dry Field Closure Technique

Hady Lichaa, MD, presents an innovative closure technique, described in his paper titled, “Dry field closure of large-bore access with iliac artery angioplasty through the ipsilateral sheath: the single-access dry-closure technique.” The paper was published by Dr. Lichaa and his colleagues, Jason Wollmuth, MD, and Rajiv Tayal, MD, in the Journal of Invasive Cardiology in July 2021. Dr. Lichaa is an assistant professor at the University of Tennessee and an interventional cardiologist at Ascension Saint Thomas Heart in Murfreesboro and Nashville, TN.

“As you know, the single access (technique) has been practice changing for 99% of us,” Dr. Lichaa states, “and has been such a huge asset to patients by decreasing morbidity with a single access.” He explains that he and his colleagues thought that there should also be a way to safely close with single access and avoid alternative access.

Dr. Lichaa describes the steps of the single-access dry-closure technique which, in a nutshell, occludes the ipsilateral iliac artery with a balloon from the sheath and enables closure while the balloon is up. The balloon is then removed over the wire and closure finalized. The technique can be used in Protected PCI, shock cases, and post-closure. Dr. Lichaa also emphasizes its use in percutaneous axillary Impella® placement and peripheral interventions. The technique avoids the time, energy, skills, and contrast needed for alternative contralateral femoral or radial to peripheral access while still permitting an angiogram, if desired, through the shaft of the balloon when it is deflated.

Dr. Lichaa explains that the technique is flexible and accommodates multiple closure devices (eg, Perclose ProGlide®, Mynx, Angio-Seal®) depending on the operator’s experience. “It’s very practical, fast, and easy to learn. The learning curve is almost nothing.”

“Ultimately, when we have a large enough series,” Dr. Lichaa concludes, “our dream is to prove that it decreases morbidity of the procedure by avoiding all of what we talked about, especially alternative access.”

Perclose ProGlide is a registered trademark of Abbott Vascular Inc.
Angio-Seal is a registered trademark of Terumo Medical Corporation