Transcatheter aortic valve replacement (TAVR) procedures frequently utilize large-bore arterial access for valve delivery. Consequently, clinicians often use the MANTA device, a collagen plug-based vascular closure tool, to achieve hemostasis. However, some patients experience significant complications, such as MANTA-related vascular occlusion. This condition typically arises from plug internalization, which blocks blood flow in the common femoral artery. Therefore, interventionalists must have a reliable strategy to address these rare but serious events.

Addressing MANTA-related vascular occlusion

A recent clinical analysis of 1445 patients demonstrated that occlusive complications occurred in approximately 2.4% of cases. Most of these incidents resulted from the device plug migrating into the vessel lumen. Specifically, 88% of the affected cohort showed signs of plug internalization leading to total vessel occlusion. To manage this, interventionalists utilized percutaneous endovascular intervention (PEI) as a primary strategy. This approach achieved a remarkable procedural success rate of 97%.

The intervention involves crossing the lesion using either an antegrade or retrograde approach. Furthermore, 85% of patients received a self-expanding stent to restore vessel patency. Specifically, an oversized VIABAHN self-expanding stent served as the primary tool for definitive treatment in 90% of those cases. While one patient required secondary surgery due to profunda artery occlusion, most outcomes remained overwhelmingly positive. Consequently, follow-up data at one month showed no reports of recurring occlusion or bleeding. Therefore, PEI represents a safe and reliable method for managing these complex vascular events.

Frequently Asked Questions

What is the most common cause of vessel occlusion with the MANTA device?

The primary mechanism for occlusion is plug internalization, where the collagen plug migrates into the vessel lumen instead of staying on the exterior wall. This occurred in 88% of the complication cohort studied.

How successful is PEI in treating MANTA-related complications?

Percutaneous endovascular intervention (PEI) is highly effective, with studies reporting a 97% procedural success rate. Most patients can be treated without the need for open surgical repair.

What is the preferred treatment for restoring vessel patency?

Stenting is considered the definitive treatment for 85% of patients. In particular, self-expanding stents like the VIABAHN are commonly used to resolve the occlusion and secure the vessel wall.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. Refer to the latest local and national guidelines for clinical practice.

References

Haberman D et al. Percutaneous Endovascular Management of MANTA-Related Vascular Occlusion. Catheter Cardiovasc Interv. 2026 Mar 16. doi: 10.1002/ccd.70556. PMID: 41839741.

Van Mieghem NM et al. Safety and effectiveness of the MANTA large bore vascular closure device: A prospective, multicenter study. JACC Cardiovasc Interv. 2017 Mar 27;10(6):613-619.

De Palma R et al. Impact of Percutaneous Femoral Arteriotomy Closure Using the MANTA Device on Vascular and Bleeding Complications After Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv. 2018 Nov 1;92(5):954-961.