Optimizing MANTA Closure and Bailout in Large-Bore Femoral Access: Computed Tomography Angiography-Derived Measurements and Rescue Strategies.

Background: The MANTA (Teleflex, Wayne, PA, USA) facilitates hemostasis in large-bore femoral access. However, precise measurement of the common femoral artery depth is required before arteriotomy upsizing. This measurement may be unavailable in emergencies or bailout scenarios for suture-based closures.

Aims: This study aimed to evaluate computed tomography (CT) angiography-derived common femoral artery depth measurement as an alternative to the MANTA Depth Locator.

Methods: This retrospective study at MedStar Washington Hospital Center included all patients with available preprocedural ilio-femoral CT angiography undergoing transfemoral aortic valve reintervention from March 13, 2023, to September 4, 2024. CT measurements of skin-to-artery depth at a designated puncture site, based on the MANTA Instructions for Use 45-degree approach, were compared with intraprocedural MANTA Depth Locator measurements. The acceptable threshold for agreement was defined as ±2 cm to ensure safe in-vessel deployment.

Results: Among 289 patients (mean age 78.2 years, 43.6% female), 91% of CT-derived measurements fell within the 2 cm threshold, demonstrating strong agreement. Logistic regression showed that a higher BMI reduced accuracy, with each unit increase in BMI decreasing the odds of meeting the threshold by 11% (OR 0.89; p < 0.001). For patients with BMI ≤ 30 kg/m² (n = 189), the agreement increased to 96%.

Conclusions: CT angiography-derived measurements align well with MANTA Depth Locator measurements, although accuracy declines with increasing BMI. These findings support CT imaging as a reliable alternative to MANTA bailout in large-bore access procedures. A practical algorithm for MANTA bailout techniques is proposed to guide clinical practice.