Ischemic complications of percutaneous femoral artery catheterization

Vascular Access and Management of Complications

Vascular access requires a deliberate and thoughtful approach. Optimal femoral access involves understanding anatomic, fluoroscopic, and ultrasound principles. Combining all 3 approaches optimizes femoral access and minimizes complications, with ultrasound guidance showing the most promising results for procedural success and safety. Transradial access for PCI and peripheral interventions offers benefits like reduced complications, shorter hospital stays, and improved safety. However, challenges include equipment limitations, radial spasm, and procedural complexity. Lower extremity interventions carry risks of access site complications. Prevention involves careful access technique, imaging, and timely management, including endovascular or surgical interventions for severe cases.

Initial experience with the AXERA 2 Femoral Access System in neurovascular procedures

INTRODUCTION

Conventional cerebral angiography is a commonly performed procedure in medicine. Vascular closure devices have been developed as alternatives to manual compression at the arteriotomy site and prolonged bed rest. The risks of using these devices include arterial dissection, groin hematoma, and device failure. Herein, we describe our experience with the use of a novel device used for arterial access and closure, the AXERA 2 Access System.

METHODS

A total of 13 patients underwent vascular access and closure with the AXERA 2 Access System.

RESULTS

Arterial access using the AXERA 2 Access System was achieved in 11 of 13 patients. Amongst the patients with successful access, one patient experienced a groin hematoma requiring manual compression and two patients suffered occlusions of the common femoral artery due to dissections, with both patients requiring femoral artery thromboendarterectomies.

CONCLUSIONS

This small series highlights a heretofore underreported serious complication rate of the AXERA 2 Access System. Additional studies are warranted to provide further insight into risk factors for device failure and complication development.

Incidence of delayed angiographic femoral artery complications using the EXOSEAL vascular closure device

BACKGROUND AND PURPOSE

Femoral artery injuries are known complications of percutaneous vascular closure devices (VCDs). We studied the incidence of delayed femoral artery angiographic irregularities after neurointerventional procedures in which the EXOSEAL extravascular closure device was used for femoral arterial puncture closure.

METHODS

Adult patients who underwent femoral arterial puncture closures with an EXOSEAL VCD and had a follow-up femoral artery angiogram from June 2012 through August 2013 were reviewed. A blinded radiologist compared pre-deployment and follow-up femoral arteriograms for the presence of femoral artery stenosis, dissection, pseudoaneurysm, or development of an arteriovenous fistula. Hospital records were reviewed for major or minor complications of the groin site or femoral artery.

RESULTS

The EXOSEAL VCD achieved hemostasis, without evidence of a groin hematoma or requiring subsequent prolonged manual compression, in 400 of 441 closures following transfemoral arterial access, representing a device success rate of 90.7%. A total of 98 patients underwent 102 repeat angiograms following closure with the EXOSEAL VCD. The average time to the repeat angiogram was 73.5 days (range 0-488, median 28). Follow-up femoral arteriography demonstrated an irregularity in seven cases, all of which were vessel stenoses of <50%. There were no dissections, pseudoaneurysms, infections, or ischemic events in the study population.

CONCLUSIONS

Angiographic irregularities were seen in 6.86% of cases after closure with the EXOSEAL VCD. There were no clinically significant vascular complications. Thus, femoral artery closure with EXOSEAL carries a low risk of clinically significant delayed angiographic findings.