Cross-Seal Closure Device IDE Trial - Study of the Cross-SealTM Suture-Mediated Vascular Closure Device System

The Cross-Seal device is a VCD intended for use in catheterization laboratories following percutaneous cardiac or peripheral procedures that use the retrograde common femoral artery access route for large bore (8-18F ID) interventional devices. The function of Cross-Seal is to percutaneously close the puncture in the artery wall (arteriotomy) through which the catheters were inserted for the procedure.

The study is being conducted to demonstrate the safety and effectiveness of Cross-Seal in achieving hemostasis in femoral arterial access sites in subjects undergoing percutaneous transcatheter interventional procedures using a large-bore procedure sheath.

Inclusion criteria

• Subject is ≥ 18 years old
• Subject is scheduled for elective or planned (i.e., not emergent or urgent) percutaneous transcatheter interventional procedures involving access through the femoral artery using 8-18 French introducer sheaths
• Subject is able to undergo emergent vascular surgery if a complication related to the vascular closure necessitates such surgery
• Subject is willing and able to complete follow-up requirements
• Subject, or authorized representative signs a written Informed Consent form prior participating in the study

Exclusion criteria

General Exclusion Criteria

• Prior intra-aortic balloon pump at access site
• Subjects with severe inflow disease (iliac artery diameter stenosis > 50%) and/or severe peripheral arterial disease (Rutherford Classification 5 or 6), as confirmed with prior standard of care Computed Tomography Imaging, duplex ultrasound, and/or intra-procedural fluoroscopy
• Common femoral artery lumen diameter is < 5 mm
• In opinion of the investigator, significant scarring of the target access site which would preclude use of the device in accordance with the IFU
• Prior target artery closure with any closure device < 90 days, or closure with manual compression ≤ 30 days prior to index procedure
• Prior vascular surgery, vascular graft, or stent in region of access site
• Subjects receiving glycoprotein IIb/IIIa inhibitors before, during, or after the catheterization procedure
• Subjects with significant anemia
• Subject with known bleeding disorder including thrombocytopenia (platelet count < 100,000), thrombasthenia, hemophilia or Von Willebrand's disease
• Subject with renal insufficiency, on dialysis therapy, or with renal transplant
• Known severe allergy to contrast reagent that cannot be managed with premedication
• Inability to tolerate aspirin and/or other anticoagulation/antiplatelet treatment
• Planned anticoagulation therapy post-procedure such that the Activated Clotting Time (ACT) is expected to be elevated above 350 seconds for more than 24 hours after the procedure
• Connective tissue disease (e.g., Marfan's Syndrome)
• Thrombolytics (e.g., streptokinase, urokinase), Angiomax (bivalirudin) or other thrombin-specific anticoagulants ≤ 24 hours prior to the procedure
• Recent (within 8 weeks) cerebrovascular accident or Q-wave myocardial infarction
• Subjects who are morbidly obese
• Planned major intervention or surgery, including planned endovascular procedure in the target leg, within 30 days following the interventional procedure
• Subject unable to ambulate at baseline (i.e., confined to wheelchair or bed)
• Currently participating in a clinical study of an investigational device or drug that has not completed its primary study endpoint
• Known allergy to any device component
• Subject is known or suspected to be pregnant or lactating
• Evidence of active systemic or local groin infection
• Subject has other medical, social or psychological problem that in the opinion of the investigator precludes them from participating
• Subject is mentally incompetent or a prisoner
• New York Heart Association (NYHA) Class IV heart failure that is uncontrolled and requires treatment in the Intensive Care Unit within 24 hours prior to the index procedure
• Left Ventricular Ejection Fraction (LVEF) < 20%
• Unilateral or bilateral lower extremity amputation
• Known existing nerve damage in the target leg
• Subjects who have already participated in this study

Intra-Procedure Exclusion Criteria

• Access site above the most inferior border of the inferior epigastric artery (IEA) and/or above the inguinal ligament based upon bony landmarks
• Access site in the profunda femoris or superficial femoral arteries, or the bifurcation of these vessels
• Ipsilateral femoral venous sheath during the catheterization procedure
• Common femoral artery calcium, which is visible with prior Computed Tomography Imaging and/or duplex ultrasound
• Subject in which there is difficulty inserting the introducer sheath or need for greater than 2 ipsilateral arterial punctures at the start of the catheterization procedure
• Difficulty in obtaining vascular access resulting in multiple arterial punctures and/or posterior arterial puncture
• Evidence of a pre-existing hematoma (> 1.5 cm in diameter), arteriovenous fistula, pseudoaneurysm, or intraluminal thrombosis at the access site
• Marked tortuosity (at the investigator's discretion) of the femoral or external iliac artery in the target leg based on prior Computed Tomography imaging, fluoroscopy, and/or duplex ultrasound
• Angiographic evidence of arterial laceration, dissection, or stenosis in the femoral artery that would preclude use of the investigational device
• Target arteriotomy >18 French sheath