The double angio-seal technique for arterial closure following large-bore access.

Off-label "double-wire" technique for closure of large-bore vascular access has been reported in the setting of percutaneous aortic valvuloplasty. We present 5 cases of high-risk percutaneous coronary intervention (HRPCI) supported by a 2.5 LP Impella assist device with 13 and 14 Fr size femoral access. Following successful HRPCI, vessel closure was complicated by unsuccessful deployment of a suture-mediated closure device. Subsequently, deployment of two successive collagen-based closure devices with a "double-wire" technique was performed. Our cases warrant further studies to test the feasibility of using double-closure device as an alternative for vessel closure when left ventricular assist devices are needed to support HRPCI.