Percutaneous Endovascular Management of MANTA‐Related Vascular Occlusion

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Abstract
Background: Vascular closure devices (VCDs) are the standard alternative to surgical cutdown for large‐bore arterial access (LBAA) but can lead to complications like bleeding and common femoral artery (CFA) occlusion that require intervention. This manuscript outlines our approach using percutaneous endovascular intervention (PEI) to manage femoral artery occlusion caused by the MANTA (Teleflex, Morrisville, SC), the only collagen plug‐based VCD indicated for LBAA. Methods: Consecutive patients who experienced occlusive complications following MANTA deployment at the conclusion of transcutaneous aortic valve replacement (TAVR) underwent PEI to address occlusion. Clinical and procedural characteristics of the patients, as well as their short‐ and long‐term follow‐up data, were analyzed. Results: A total of 1445 patients underwent TAVR, in whom LBAA was closed with MANTA VCD between August 2017 and July 2024, among whom 34 patients (2.4%) experienced occlusive complications. These patients had a mean age of 79 ± 8 years, and 59% were female. The mean CFA diameter was 7.8 ± 1.1 mm, with mild vessel stenosis present in 41% and calcification in 44% of patients. An 18 French MANTA device was used for closure in 82% of patients. The primary mechanism was plug internalization, which was observed in 88% of our cohort and led to total vessel occlusion in 56% of patients. Bleeding occurred in 38% of patients in association with occlusion. All patients were approached with PEI, achieving an overall procedural success rate of 97%. Lesion crossing was accomplished via an antegrade approach in 71% of patients, with the remaining 29% requiring a retrograde approach. Stenting was the definitive treatment in 85% of patients, with 90% of these involving an oversized VIABAHN (Gore Medical, Newark, DE) self‐expanding stent. One patient experienced profunda artery occlusion after stent placement that required surgery. At 1‐month follow‐up, no vessel occlusions or bleeding were reported. Conclusion: Femoral artery occlusion from MANTA deployment after TAVR can be effectively treated with PEI. Low complication rates at 1 month suggest PEI is safe and reliable, but longer follow‐up is needed to assess long‐term vessel outcomes.

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