1
|
Bystrom PV, Kulangara R, El Khoury R, Piel M, Chaney M, Jacobs CE, White JV, Schwartz LB. Totally Extravascular Bioresorbable Closure Reduces Access Complications after Endovascular Peripheral Intervention. Ann Vasc Surg 2025; 119:111-120. [PMID: 40316207 DOI: 10.1016/j.avsg.2025.04.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 04/10/2025] [Accepted: 04/13/2025] [Indexed: 05/04/2025]
Abstract
BACKGROUND Percutaneous closure of the access artery has become commonplace after endovascular intervention. In patients with peripheral vascular occlusive disease, however, control of the puncture site is more problematic as the access artery is frequently plaque-laden and stenotic. Ischemic complications in the access extremity are more common in these cases, particularly when using devices that depend on the deployment of prosthetic material within the compromised arterial lumen. The purpose of this retrospective clinical study was to assess the efficacy of totally extravascular bioresorbable closure (TEBC) of the femoral artery puncture sites after percutaneous peripheral intervention (PPI). METHODS Consecutive PPIs performed at single institution between 2015 and 2020 were studied. Demographic characteristics and the incidence of access complications were recorded. The complication rate of TEBC and manual compression (MC) were analyzed with multivariate regression analysis. Major complications were defined as the composite of acute arterial ischemia, major bleeding, and/or pseudoaneurysm requiring operation. Minor complications were defined as the aggregate of transient hypotension, groin hematoma, and/or arteriovenous fistula. RESULTS A total of 507 PPIs were performed in 345 patients during the study period. The mean age was 74 years; comorbidities were prevalent, including diabetes (57%), obesity (28%), and end-stage renal failure requiring dialysis (10%). Indications for PPI were either chronic limb-threatening ischemia (CLTI) (68%) or claudication (32%). All procedures were performed using femoral artery access in a retrograde (93%) or antegrade (7%) fashion with ≤5 Fr (21%), 6 Fr (18%), or ≥7 Fr (61%) sheaths. Control of the femoral artery puncture site was achieved by either MC (75%), or TEBC (25%). TEBC became the exclusive closure method in 2019. Acute arterial ischemia rarely complicated MC (1.3%) but was not observed in any patient undergoing TEBC. Bleeding and/or pseudoaneurysms requiring reoperation were also rare (MC 0.3% vs. TEBC 1.6%; P = 0.64). On multivariate analysis, there was no difference in major access complications between MC and TEBC (odds ratio [OR] = 1.45 [0.27-7.79]; P = 0.66), while minor access complications were significantly reduced with the use of TEBC (OR = 0.39 [0.19-0.75]; P < 0.01). CONCLUSION TEBC after PPI for peripheral arterial disease is safe and effective. There were no instances of acute arterial ischemia following TEBC in this series, and TEBC significantly reduced the incidence of minor access complications compared to MC. Given the bioresorbable design of the device and the lack of an intraluminal component of any kind, TEBC may be the ideal closure device for patients with peripheral arterial disease undergoing endovascular intervention.
Collapse
Affiliation(s)
- Philip V Bystrom
- Department of Surgery, University of Illinois at Chicago, Chicago, IL.
| | - Rohan Kulangara
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Rym El Khoury
- Division of Vascular Surgery, Department of Surgery, Northshore University Health System/Endeavor Health, Evanston, IL
| | - Mitchell Piel
- Rosalind Franklin University of Medicine and Science, Chicago, IL
| | - Michael Chaney
- Department of Surgery, Western Michigan University School of Medicine, Kalamazoo, MI
| | - Chad E Jacobs
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Lewis B Schwartz
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| |
Collapse
|
2
|
Cheng TW, Farber A, King EG, Levin SR, Arinze N, Malas MB, Eslami MH, Garg K, Rybin D, Siracuse JJ. Access Site Complications Are Uncommon with Vascular Closure Devices or Manual Compression after Lower Extremity Revascularization. J Vasc Surg 2022; 76:788-796.e2. [PMID: 35618194 DOI: 10.1016/j.jvs.2022.03.890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vascular closure devices (VCD) and manual compression (MC) are used to achieve hemostasis following peripheral vascular interventions (PVI). We sought to compare perioperative outcomes between MC and four VCDs following PVI in a multicenter setting. METHODS The Vascular Quality Initiative was queried for all lower extremity (LE) PVIs with common femoral artery access performed from 2010-2020. VCDs included were MynxGrip® (Cordis, Santa Clara, CA, USA), StarClose SE™ (Abbott, Redwood City, CA, USA), Angio-Seal® (Terumo, Somerset, NJ, USA), and Perclose ProGlide™ (Abbott, Redwood City, CA, USA). In a blinded fashion, these four VCDs (A, B, C, D) were compared to MC for baseline characteristics, procedural details, and outcomes (access site hematoma and stenosis/occlusion). Sheath size >8 Fr were excluded. Propensity score matching (1:1) was performed. Univariable and multivariable analyses were completed for unmatched and matched data. RESULTS There were 84,172 LE PVIs identified: 32,013 (38%) used MC and 52,159 (62%) used VCDs (A-12,675;B-6,224;C-19,872;D-13,388). Overall, average age was 68.7 years and 60.4% were male; indications for intervention were most commonly claudication (43.8%) and tissue loss (40.1%). When compared to MC, VCDs were utilized more often in patients with obesity, diabetes, and end stage renal disease (all P<.001). VCDs were used less often in patients with hypertension, chronic obstructive pulmonary disease, coronary artery disease, prior percutaneous coronary and extremity interventions, and major amputation (all P<.001). VCD use was more common, compared to MC, during femoral-popliteal (73% vs. 63.8%) and tibial interventions (33.8% vs. 22.3%), but less common with iliac interventions (20.6% vs. 34.7%) (all P<.001). Protamine was used less often after VCDs (19.1% vs. 25.6%, P<.001). Overall, there were 2,003 (2.4%) hematomas of which 278 (13.9%) required thrombin/surgical intervention. When compared to MC, any VCD use had fewer hematomas (1.7% vs. 3.6%, P<.001) and hematomas requiring intervention (.2% vs. .5%, P<.001). When divided by hemostatic technique, any hematoma were MC-3.6%; A-1.4%; B-1.2%; C-2.3%; D-1.1%, P<.001. Hematomas requiring intervention were MC-.5%; A-.2%; B-.2%; C-.3%; D-.1%, P<.001. Access site stenosis/occlusion was similar between MC and any VCDs (.2% vs. .2%, P=.12). Multivariable analysis demonstrated that any VCDs and individual VCDs, vs. MC, were independently associated with fewer hematomas. Access site stenosis/occlusion was similar between any VCDs and MC. Matched analysis revealed similar findings. CONCLUSIONS Although overall rates of hematomas requiring intervention were low regardless of hemostatic technique, VCD use, irrespective of type, compared favorably to MC with significantly fewer access site complications after PVI.
Collapse
Affiliation(s)
- Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Elizabeth G King
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Nkiruka Arinze
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, University of California San Diego, San Diego, CA
| | - Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Karan Garg
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Denis Rybin
- Department of Biostatistics, Boston University, School of Public Health, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
| |
Collapse
|
3
|
Gummerer M, Kummann M, Gratl A, Haller D, Frech A, Klocker J, Fraedrich G, Gruber H. Ultrasound-Guided Fibrin Glue Injection for Treatment of Iatrogenic Femoral Pseudoaneurysms. Vasc Endovascular Surg 2020; 54:497-503. [PMID: 32552570 PMCID: PMC7346712 DOI: 10.1177/1538574420934631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention. Ultrasound-guided injection of thrombogenic substances into perfused arterial PSAs followed by compression therapy is a well-established and less invasive treatment option than surgical repair. Different agents are available to induce thrombosis including thrombin and a fibrin-based tissue glue, which is used as first-line treatment at our institution. This paper deals with our experience using ultrasound-guided fibrin glue injection (UGFI). Materials and Methods: Retrospective data analysis: all patients (55) treated for iatrogenic femoral PSA following digital subtraction angiography of the lower extremities between January 1, 2010, and December 31, 2018, were included. Data on epidemiology, PSA location and size, vascular risk factors, fibrin glue injection (fibrin glue volume), primary success rate of UFGI, and complications related to the treatment were analyzed. Results: A total of 55 consecutive femoral iatrogenic PSAs were treated during the defined period and 32 (58.2%) of the patients were female. Imaging was performed using ultrasound in all cases. The most common PSA location (80.0%) was the common femoral artery, mean PSA size (± SD) was 2.7 ± 1.2 cm, and neck length was 1.6 ± 1.0 cm. The dose (mean ± SD) of fibrin glue was 2.6 mL (± 1.0; maximum: 6 mL). Primary UGFI success rate was 87.3% and conversion rate to open surgery was 12.7%. Two (4%) patients required embolectomy for peripheral embolization after UGFI. Conclusion: Early results achieved with UGFI for treatment of iatrogenic femoral PSA are promising. In our cohort, UGFI was a safe and effective first-line alternative to traditional open surgery, which then was unnecessary in the vast majority of PSA cases. Further prospective studies for comparison of ultrasound-guided techniques should be encouraged.
Collapse
Affiliation(s)
- Maria Gummerer
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Moritz Kummann
- Department of Radiology, Medical University Innsbruck, Austria
| | - Alexandra Gratl
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Daniela Haller
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Frech
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Klocker
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Austria
| |
Collapse
|
4
|
Reich R, Rabelo-Silva ER, Santos SMD, Almeida MDA. Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review. Rev Gaucha Enferm 2018; 38:e68716. [PMID: 29933427 DOI: 10.1590/1983-1447.2017.04.68716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/28/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories. METHODS Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. RESULTS One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. CONCLUSION Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.
Collapse
Affiliation(s)
- Rejane Reich
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Simone Marques Dos Santos
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Miriam de Abreu Almeida
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| |
Collapse
|
5
|
Bague N, Costargent A, Kaladji A, Chaillou P, Vent PA, Guyomarc'h B, Quillard T, Gouëffic Y. The FREEDOM Study: A Pilot Study Examining the Feasibility and Safety of Early Walking following Femoral Manual Compression after Endovascular Interventions Using 5F Sheath-Compatible Devices. Ann Vasc Surg 2017; 47:114-120. [PMID: 28947216 DOI: 10.1016/j.avsg.2017.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/02/2017] [Accepted: 09/14/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Increasing prevalence of peripheral arterial disease (PAD) burning and pressure to reduce costs and promote patient empowerment make outpatient endovascular procedures an attractive alternative to conventional hospitalization. For outpatient peripheral endovascular procedures, femoral manual compression could replace the use of arterial closure devices for small-bore punctures. Presently, safety and feasibility evidence for femoral manual compression is still lacking. FREEDOM is a pilot study designed to demonstrate the feasibility and safety of early walking after femoral manual puncture point compression following a therapeutic endovascular procedure for PAD. METHODS From May to August 2015, all patients requiring endovascular treatment for PAD were prospectively screened. Those patients that received therapeutic endovascular procedures involving retrograde femoral punctures with a 5F sheath were included. Manual compression and pressure dressing of the femoral puncture points was applied. The primary end point was defined as the walking ability 5 hr after index procedure (H5), which was assessed by a walk test. RESULTS In total, 129 consecutive patients were screened, and 30 patients met the study criteria. The mean age was 66 ± 11 years. The mean duration of the procedure and of the manual compression was 63 ± 24 min and 12.8 ± 4 min, respectively. At 5 hr following the procedure, 97% of the patients were able to walk 100 m. Two patients failed to walk due to cardiac arrhythmia and to a false aneurysm at the femoral puncture site. No further complications were observed at 1 month, and quality of life assessed by EQ-5D test was significantly increased compare to baseline (72.3 vs. 60.4; P = 0.001). CONCLUSIONS This pilot study demonstrated the benefits of manual compression to close arterial punctures over procedures using 5F shealth-compatible endovascular devices. A sufficiently powered randomized controlled trial is needed to further characterize the potential benefits of manual compression following use of low-profile devices.
Collapse
Affiliation(s)
- Nicolas Bague
- CHU Nantes, l'Institut du Thorax, service de chirurgie vasculaire, Nantes, France; Université de Nantes, Nantes, France
| | - Alain Costargent
- CHU Nantes, l'Institut du Thorax, service de chirurgie vasculaire, Nantes, France
| | - Adrien Kaladji
- CHU Nantes, l'Institut du Thorax, service de chirurgie vasculaire, Nantes, France
| | - Philippe Chaillou
- CHU Nantes, l'Institut du Thorax, service de chirurgie vasculaire, Nantes, France
| | | | | | | | - Yann Gouëffic
- CHU Nantes, l'Institut du Thorax, service de chirurgie vasculaire, Nantes, France; Université de Nantes, Nantes, France; INSERM UMR1238, Nantes, France.
| |
Collapse
|
6
|
Fokkema TM, Minnee RC, Kock GAH, Blomjous JGAM, Vahl AC, Leijdekkers VJ. Comparison of a collagen plug arterial closure device with manual compression after endovascular interventions for peripheral artery disease. J Vasc Surg 2016; 64:104-108.e1. [PMID: 27038835 DOI: 10.1016/j.jvs.2016.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Arterial closure devices (ACDs) seem to be safe and effective to obtain hemostasis for cardiac interventions and diagnostic vascular procedures. However, only limited evidence is presented on therapeutic interventions in patients with peripheral atherosclerotic disease. We compared ischemic and hemorrhagic complications of an ACD vs manual compression (MC) after puncture of the femoral artery for endovascular lower extremity procedures. METHODS The records of all subsequent endovascular interventions for peripheral artery disease performed in a large teaching hospital, from January 2012 to April 2014, were retrospectively reviewed. The primary outcome was an ischemic complication requiring reintervention. Secondary outcomes were hematoma (needing conservative or invasive intervention) and infection (needing intervention or antibiotics). Multivariate analysis was performed to identify predictors for any complication. RESULTS The Angio-Seal (St. Jude Medical, Minnetonka, Minn) closure device was used in 244 of 463 endovascular interventions (54%). Five patients (2%) who received an ACD needed emergency surgery for ischemic complications vs none in the MC group (P = .06). Hematomas occurred in 22 patients (9%) after ACD vs in six (3%) after MC (adjusted odds ratio [OR], 3.4; 95% confidence interval [CI], 1.4-8.9; P = .015). There were no infections in either group. ACD (OR, 3.8; 95% CI, 1.5-9.7) and current smoking (OR, 2.6; 95% CI, 1.01-6.7) were independent predictors for any complication. CONCLUSIONS This study demonstrates that ACD use in patients with peripheral artery disease can lead to serious adverse events resulting in increased morbidity. Therefore, the potential benefits of an ACD over MC should be carefully weighed.
Collapse
Affiliation(s)
- Talje M Fokkema
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - Robert C Minnee
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Gert-Aldert H Kock
- Department of Interventional Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Joost G A M Blomjous
- Department of Interventional Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Anco C Vahl
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Vanessa J Leijdekkers
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Simplified swift and safe vascular closure device deployment without a local arteriogram: Single center experience in 2074 consecutive patients. Indian Heart J 2016; 68:529-38. [PMID: 27543479 PMCID: PMC4990740 DOI: 10.1016/j.ihj.2015.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 11/23/2022] Open
Abstract
Objective Vascular closure devices (VCDs), such as the Angio-Seal, a three-component hemostatic plug, have greatly facilitated the routine clinical practice in the catheterization laboratory. The manufacturer recommends a local angiogram before Angio-Seal deployment. However, from the outset, we employed a simplified routine of deploying this VCD, i.e. without use of local angiography. Methods The Angio-Seal was employed without a preceding femoral arteriogram over 8 years in 2074 consecutive patients, 72% presenting with acute coronary syndromes and subjected to coronary angiography (n = 1032) or PCI n = 1042) via a transfemoral approach with use of heparin and dual antiplatelet therapy. Results Deployment of the VCD was successful in 99.4%. Complete hemostasis was obtained in 98% of cases. In 14 patients, Angio-Seal deployment failed. Mean time for placement of Angio-Seal was <1 min, to-hemostasis 1 min, and to-mobilization 3 h. Only 3 (0.15%) patients had a major complication with vessel occlusion that required emergent vascular surgery with a successful outcome. Two patients developed a local pseudoaneurysm treated with ultrasonography-guided compression. Six small and 4 large inguinal hematomas (one requiring blood transfusion) and 5 cases of retroperitoneal bleeding (one requiring blood transfusion) were recorded. Conclusion Deployment of Angio-Seal without use of local angiography was efficacious and safe, characterized by a high success rate of deployment and hemostasis with few correctable complications in a large patient cohort undergoing transfemoral catheterization for PCI and non-PCI procedures under anticoagulation and antiplatelet drug therapy. VCD reduced the time-to-hemostasis and time-to-mobilization and minimized the incidence of complications.
Collapse
|
8
|
Major femoral vascular access complications after coronary diagnostic and interventional procedures: A Danish register study. Int J Cardiol 2016; 202:604-8. [DOI: 10.1016/j.ijcard.2015.09.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/18/2015] [Indexed: 11/17/2022]
|
9
|
Amer O, Binger S, Desch S, Harnoss HM, Schuler G, Thiele H, Eitel I. Incidence, predictors, and treatment options of critical limb ischaemia after use of collagen plug-based vascular closure devices. EUROINTERVENTION 2015; 11:816-23. [PMID: 26603989 DOI: 10.4244/eijv11i7a166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Limited data are available on the frequency and predictors of vascular closure device (VCD) failure with subsequent vascular complications. The aim of this study was to investigate the incidence, clinical characteristics, and treatment options in patients with critical limb ischaemia (CLI) after use of a collagen plug-based VCD. METHODS AND RESULTS A high-volume, single-centre prospectively maintained database was retrospectively interrogated, and cases of collagen plug-based VCD-related CLI were identified between June 2006 and December 2013. CLI was defined as acute onset of rest pain after VCD application requiring endovascular or surgical treatment. Among 13,595 coronary procedures, 43 patients (0.3%) were identified with an Angio-Seal-related CLI. In a multivariable logistic regression analysis, peripheral artery disease and renal insufficiency were identified as independent predictors for CLI after Angio-Seal application. Treatment was performed in 27 patients (63%) by surgery and in 16 patients (37%) with endovascular angioplasty. CONCLUSIONS CLI after use of a collagen plug-based VCD is rare. Peripheral artery disease was identified as an independent predictor of CLI. Interventional cardiologists should be aware of potentially high-risk patients and complications after use of a VCD to provide prompt and adequate therapy.
Collapse
Affiliation(s)
- Omran Amer
- Department of Internal Medicine - Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
| | | | | | | | | | | | | |
Collapse
|
10
|
Krishna RK, Kherada N, Beohar N. Late onset iatrogenic limb ischaemia after deployment of an Angio-Seal vascular closure device. BMJ Case Rep 2015; 2015:bcr-2015-209393. [PMID: 25917071 DOI: 10.1136/bcr-2015-209393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is common practice to deploy a vascular closure device for access site closure after percutaneous angiography or cardiovascular interventions for immediate haemostasis and to facilitate early discharge. We encountered two octogenarian women who underwent and had subsequent vascular access site closure with Angio-Seal (St Jude) and who later presented with limb ischaemia needing surgical revascularisation. Our patients had undergone uneventful deployment of the Angio-Seal vascular closure device (VCD) at the right common femoral artery (CFA) access site with successful haemostasis. About 3 weeks later they presented with features of limb ischaemia needing further diagnostic work-up including repeat angiography, which revealed subtotal occlusion of right common femoral artery at the level of prior access and Angio-Seal deployment site. Both the patients underwent successful surgical repair with restoration of distal flow and resolution of symptoms. These cases illustrate the late presentation of VCD-related complications with limb ischaemia, needing surgical revascularisation.
Collapse
Affiliation(s)
- Rama K Krishna
- Department of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Nisharahmed Kherada
- Department of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Nirat Beohar
- Department of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| |
Collapse
|
11
|
Lucatelli P, Cannavale A, Cirelli C, d’Adamo A, Salvatori FM, Fanelli F. Use of ultrasound in the insertion of a vascular closure device: a comparative retrospective study with the standard blind technique. Radiol Med 2014; 120:283-8. [DOI: 10.1007/s11547-014-0439-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/06/2014] [Indexed: 10/24/2022]
|
12
|
Clinical and economic evaluation of ambulatory endovascular treatment of peripheral arterial occlusive lesions. Ann Vasc Surg 2013; 28:137-43. [PMID: 24183403 DOI: 10.1016/j.avsg.2013.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ambulatory management of patients is an alternative to conventional hospitalization. In this study we evaluate the results of a prospective cohort study of patients receiving ambulatory endovascular treatment for peripheral arterial lesions. METHODS From June 2008 to October 2010, ambulatory management was proposed for endovascular treatment of peripheral arterial lesions. An arterial closure device (Angio-Seal(®); St. Jude Medical) was used. For ambulatory treatment, patients were prohibited from driving a vehicle at discharge, had to be accompanied the first night after the procedure, had to live <1 hour from a medical facility, had to be reachable by telephone the day after the intervention, and had to remain hospitalized in the event of a complication. The principal criterion was morbimortality at 1 month. Secondary criteria were clinical improvement, patency, complications related to the arterial closure, and costs evaluation at 1 month. RESULTS Forty-five patients were included and 50 ambulatory procedures were carried out. The patients presented with claudication (92%) or a critical ischemia (8%) of the lower extremities. All procedures were carried out by femoral puncture (retrograde in 94% and anterograde in 6% of the cases). The patients presented with iliac (68%) and femoropopliteal (64%) lesions. Lesions included stenoses (70%), thromboses (16%), and intrastent restenoses (14%). The rate of failure of ambulatory hospitalization was 16% (n = 8) without a serious undesirable event: 2 patients were hospitalized after a surgical conversion for iliac rupture and disinsertion of stent; 3 patients developed a hematoma during the intervention at the point of puncture; and in 3 cases the system of percutaneous closure failed. The mean duration of hospitalization was 1.36 ± 1.33 days. At 1 month, clinical improvement was observed in 97.5% of cases, with a primary patency of 100%. No perioperative rehospitalization or puncture site complications were observed. Ambulatory management made it possible to save 42 days of hospitalization, with associated costs of 10,971€, compared with conventional hospitalization. The additional costs related to use of the Angio-Seal amounted to 7427€. CONCLUSION Ambulatory endovascular treatment of patients presenting with peripheral arterial lesions is reliable and effective and may contribute to savings in healthcare spending.
Collapse
|
13
|
Goltz JP, Ritter CO, Kellersmann R, Klein D, Hahn D, Kickuth R. Endovascular Treatment of Popliteal Artery Segments P1 and P2 in Patients With Critical Limb Ischemia: Initial Experience Using a Helical Nitinol Stent With Increased Radial Force. J Endovasc Ther 2012; 19:450-6. [DOI: 10.1583/11-3591mr.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
14
|
Comments regarding 'Influence of use of a vascular closure device on incidence and surgical management of access sites. Complications after percutaneous interventions'. Eur J Vasc Endovasc Surg 2011; 42:236-7. [PMID: 21592825 DOI: 10.1016/j.ejvs.2011.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 04/18/2011] [Indexed: 11/21/2022]
|