xDot Access Management System Pivotal Study

Inclusion Criteria:

1. Age ≥ 18 years
2. Willing and able to provide written informed consent prior to initiation of study procedures
3. Willing and able to comply with the protocol-specified procedures and assessments
4. Investigator opinion suitable for xDot AMS for femoral closure (arterial or venous, as applicable)

5. Minimum vessel diameter of 5.5 mm and vessel depth ≥1.5 cm and ≤5.0 cm, <50% stenosis for the:

   1. femoral artery, as determined by pre-procedural computed tomography angiography (CTA) and confirmed by ultrasound at the time of procedure (arterial vessel sizing can be assessed by ultrasound at index procedure if pre-procedure CTA is not SOC).
   2. femoral vein, as determined by ultrasound at the time of procedure.

6. Candidate for elective or planned (i.e., not emergent or urgent) percutaneous transcatheter interventional procedure through:

   1. The common femoral artery using 8F to 22F devices or sheaths (max 26F OD; including, but not limited to TAVR and EVAR)
   2. The common femoral vein using 8F to 26F devices or sheaths (max 30F OD; including, but not limited to transcatheter mitral/tricuspid valve repair/replacement and LAA occlusion)

Exclusion Criteria:

1. If female, individuals who are pregnant, planning to become pregnant, or lactating
2. Immunocompromised or with pre-existing autoimmune disease
3. Active systemic infection or a local infection at or near the access site
4. Known or suspected COVID-19 infection
5. Significant anemia (hemoglobin <10 g/dL, hematocrit <30%)
6. Morbidly obese or cachectic (Body mass index [BMI] >40 kg/m^2 or <20 kg/m^2)
7. Severe co-existing co-morbidities which, in the opinion of the investigator, would clinically confound the study primary endpoints
8. Known bleeding disorder including thrombocytopenia (platelet count <100,000 cells/UL), thrombasthenia, hemophilia, or von Willebrand disease
9. Allergy to any device material, including polypropylene, NiTinol, or Titanium
10. Common femoral artery or vein with calcium, as determined by baseline CTA or angiogram, which, in the clinical judgment of the investigator, precludes safe access, or severe peripheral vascular disease as evidenced by severe claudication when ambulating <100 feet, weak or absent pulses in the affected limb, or ankle-brachial index (ABI) <0.5 at rest
11. Previous iliofemoral intervention in the region of the access site, including prior atherectomy, stenting, or surgical or grafting procedures
12. Use of an intra-aortic balloon pump through the access site within 30 days prior to the baseline evaluation
13. Continuous oral anticoagulation therapy that cannot be stopped for the peri-procedural period or international normalized ratio (INR) >1.8 at the time of the procedure
14. Unable to be adequately anti-coagulated for the procedure
15. Unable to ambulate at baseline (e.g., wheelchair user or confined to bed)
16. ST-elevation myocardial infarction (MI) within 30 days prior to procedure or acute coronary syndrome (i.e., unstable angina or MI) ≤30 days before the catheterization procedure
17. New York Heart Association (NYHA) class IV heart failure
18. Left ventricular ejection fraction <20%
19. Unilateral or bilateral lower extremity amputation
20. Renal insufficiency (serum creatinine >2.5 mg/dl) or on dialysis therapy
21. Existing nerve damage in the ipsilateral leg
22. Additional planned endovascular procedure within the next 30 days
23. Currently participating in another clinical trial of an unapproved investigational device or drug that has not concluded the follow-up period
24. Vulnerable subject populations (e.g., incarcerated or cognitively challenged adults)