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\begin{document}

\title{Occlusion Following Deployment Of MANTA VCD After TAVR}



\author[1]{Mohammed Hassan}%
\author[1]{Timothy Mixon}%
\author[1]{William Gray}%
\author[1]{Ramachandra Reddy}%
\affil[1]{Scott and White Memorial Hospital}%


\vspace{-1em}



  
  \date{June 15, 2024}


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\selectlanguage{english}
\begin{abstract}
We present a complication following deployment of the MANTA VCD device
following a TAVR procedure which resulted in occlusion of the common
femoral artery. This was addressed by ballooning the site from the
contralateral side which re-established flow. We believe this is the
first report to address this kind of complication and may prove useful
as more of the MANTA devices are being used in multiple procedures.%
\end{abstract}%



\sloppy


Occlusion Following Deployment Of MANTA VCD After TAVR

Mohammed F. Hassan MD\textsuperscript{1}, Timothy
Mixon\textsuperscript{2}, William Todd Gray\textsuperscript{3},
Ramachandra Reddy MD\textsuperscript{1}

\begin{enumerate}
\tightlist
\item
  Division of Cardiothoracic Surgery, CardioVascular Institute- Baylor
  Scott \& White Medical Center, Temple, Texas
\item
  Division of Cardiology- Baylor Scott \& White Medical Center, Temple,
  Texas
\item
  Division of Cardiology- Baylor Scott \& White Medical Center, College
  Station, Texas
\end{enumerate}

Corresponding Author:

Mohammed Hassan, MD, MBA

Associate Professor, Texas A \& M University, COM

Baylor Scott \& White Memorial Hospital

2401 S. 31\textsuperscript{st} St.

Temple, Texas

76508

Mobile- 513-460-3499

Word Count: 232

63 year-old patient with symptomatic severe aortic stenosis underwent
TAVR with 23mm Edwards Sapien valve through the left common femoral
artery (CFA). After successful valve deployment and closure with MANTA
VCD, an angiogram was obtained from the contralateral leg which showed
subtotal occlusion at the deployment site and absence of doppler signals
at the left foot (Fig. 1). A Glide wire was passed from the
contralateral side through the narrowing into the superficial femoral
artery. A 4.0 x 40mm Mustang balloon was inflated to 10mmHg (Fig.2).
Subsequent completion angiogram showed a patent vessel and normal
doppler signals had returned (Fig.3). We hypothesize that this subtotal
occlusion occurred due to the footplate, or toggle, which measures 18 mm
x 6 mm, likely getting caught on the carina of the femoral bifurcation
due to low puncture within the CFA. We believe this is the first report
to address this kind of complication and may prove useful as more of the
MANTA devices are being used in multiple procedures such as TAVR and
Extracorporeal membrane oxygenation (ECMO)
decannulation.\textsuperscript{1,2}

References:

\begin{enumerate}
\tightlist
\item
  Hassan MF, Lawrence M, Lee D, et al. Simplified percutaneous VA ECMO
  decannulation using the MANTA vascular closure device: Initial US
  experience. Journal of Cardiac Surgery. 2020 Jan;35(1):217-221. DOI:
  10.1111/jocs.14308.
\item
  Van Gils Lennart, De Jaegere Peter PT, Roubin Gary, Van Mieghem
  Nicolas M. The MANTA vascular closure device. JACC: Cardiovasc Interv.
  2016;9(11):1195-1196. https://doi.org/10.1016/j.jcin.2016. 03.010
\end{enumerate}

Legend:

Figure 1: Occlusion at deployment site of MANTA proximal to the common
femoral artery bifurcation

Figure 2: Ballooning at the MANTA site from the contralateral common
femoral artery

Figure 3: Post-ballooning of occlusion showing a patent common femoral
artery\selectlanguage{english}
\begin{figure}[H]
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\includegraphics[width=0.70\columnwidth]{figures/Manta-occlusion-1-jpeg/Manta-occlusion-1-jpeg}

\end{center}
\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Manta-balloon-jpeg/Manta-balloon-jpeg}

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\end{figure}\selectlanguage{english}
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\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Manta-post-balloon-jpeg/Manta-post-balloon-jpeg}

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\end{figure}

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