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El-Abd Y, Angle JF. Closure Devices. IMAGE-GUIDED INTERVENTIONS 2020:62-64.e1. [DOI: 10.1016/b978-0-323-61204-3.00008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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2
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Boschewitz JM, Pieper CC, Andersson M, Nadal J, Schild HH, Meyer C. Efficacy and time-to-hemostasis of antegrade femoral access closure using the ExoSeal vascular closure device: a retrospective single-center study. Eur J Vasc Endovasc Surg 2014; 48:585-91. [PMID: 25201516 DOI: 10.1016/j.ejvs.2014.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/01/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To retrospectively evaluate the efficacy and time-to-hemostasis of antegrade femoral access closure using the ExoSeal vascular closure device (VCD). DESIGN Retrospective, single-center analysis. MATERIALS AND METHODS Between September 2010 and February 2013, 148 ExoSeal VCD closures (5-7F) of antegrade femoral accesses were performed in 119 patients (70 males, mean age 71.6 years, range 40-97 years). In all cases initial diagnostic angiography was performed via an 18G/3.8F retrograde femoral access, which was left in place during intervention (in-house standard) and was used to obtain control angiography after successful closure of the antegrade access to determine hemostasis. Technical device success was defined as ExoSeal closure without major VCD-related complications; procedural success as hemostasis within 5 minutes. Statistical analysis was performed using a logistic regression model and correlation analyses. RESULTS 145/148 (98.0%) ExoSeal closures were technically successful (5F: n = 76; 6F: n = 65; 7F: n = 7). Angiographic control showed closure after 2 minutes in 130/145 cases. In a further 14 cases hemostasis was achieved after an additional 3 minutes MC, so that closure was successful within 5 minutes in 144/148 cases (97.3%). No major complication occurred. One minor complication was recorded in a 6F access case. Pre-interventional activated partial thromboplastin time (aPTT) was the only statistically significant predictor of necessary manual compression (MC) > 2 minutes (p = .01), but with an odds-ratio of only 1.038. The INR showed an odds-ratio of 2.455 for need for 5 minutes MC (NS). Significant correlations were found between the need for 5 minutes MC and medication with acetylsalicylic acid (p = .01), clopidogrel (p < .01), and abciximab (p < .001). CONCLUSION ExoSeal vascular closure of antegrade femoral punctures is safe and effective with a low complication rate. Two minutes of MC are sufficient to achieve hemostasis in the majority of cases. However, in patients on antiplatelet therapy, especially after abciximab, the authors advocate prolonging MC to 5 minutes.
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Affiliation(s)
- J M Boschewitz
- Department of Radiology, University of Bonn, Bonn, Germany
| | - C C Pieper
- Department of Radiology, University of Bonn, Bonn, Germany
| | - M Andersson
- Department of Radiology, University of Bonn, Bonn, Germany
| | - J Nadal
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - H H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - C Meyer
- Department of Radiology, University of Bonn, Bonn, Germany.
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Boschewitz JM, Andersson M, Naehle CP, Schild HH, Wilhelm K, Meyer C. Retrospective evaluation of safety and effectiveness of the EXOSEAL vascular closure device for single vascular closure and closure after repeat puncture in diagnostic and interventional radiology: single-center experience. J Vasc Interv Radiol 2013; 24:698-702. [PMID: 23622041 DOI: 10.1016/j.jvir.2013.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To retrospectively evaluate the safety and effectiveness of the EXOSEAL vascular closure device (VCD) for first or repeated closure after retrograde percutaneous femoral arterial access. MATERIALS AND METHODS A retrospective analysis of 417 patients (271 men; mean age, 64.1 y±12.8; age range, 22-94 y) who had undergone arterial closure with the EXOSEAL VCD was performed. Procedures with retrograde femoral access and closure with the 5-F, 6-F, or 7-F EXOSEAL VCD according to the manufacturer's instructions were included. The clinical indications included the full procedural portfolio of a radiologic department with a focus on transarterial hepatic procedures. After EXOSEAL VCD closure, patients were restricted to bed rest for 4 hours. RESULTS From August 2010 to March 2012, a total of 682 EXOSEAL VCDs (5-F, n = 276; 6-F, n = 394; 7-F, n = 12) were used in 659 procedures with a total of 404 repeated closures. The EXOSEAL VCD was used successfully in 676 of 682 procedures (99.1%). Hemostasis was achieved in 651 of 682 procedures (95.5%). No major complications were encountered. There were eight cases (1.17%) of minor complications despite a successful vascular closure procedure, none requiring further therapy. There were no complications in any of the 404 cases of repeated vascular closure. CONCLUSIONS The results of this study suggest that the EXOSEAL VCD is safe and effective in single and repeated closure of retrograde percutaneous femoral arterial access in interventional radiology cases.
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Affiliation(s)
- Jack M Boschewitz
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany
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Vavuranakis M, Kariori M, Voudris V, Kalogeras K, Vrachatis D, Aznaouridis C, Moldovan C, Masoura C, Thomopoulou S, Lazaros G, Stefanadis C. Predictive Factors of Vascular Complications after Transcatheter Aortic Valve Implantation in Patients Treated with a Default Percutaneous Strategy. Cardiovasc Ther 2013; 31:e46-54. [DOI: 10.1111/1755-5922.12023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Manolis Vavuranakis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Maria Kariori
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Vassilis Voudris
- 2nd Department of Cardiology; Onassis Cardiac Surgery Center; Athens; Greece
| | - Konstantinos Kalogeras
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Dimitrios Vrachatis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Constantinos Aznaouridis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Carmen Moldovan
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Constantina Masoura
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Sophia Thomopoulou
- 2nd Department of Cardiology; Onassis Cardiac Surgery Center; Athens; Greece
| | - Georgios Lazaros
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Christodoulos Stefanadis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
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Hong D, Lee SH, Chung HH, Seo BK, Cha SH, Lee KY, Ahn JC. Fluoroscopic guided fogarty embolectomy for an angio-seal embolism in the popliteal artery. Korean J Radiol 2013; 14:636-9. [PMID: 23901321 PMCID: PMC3725358 DOI: 10.3348/kjr.2013.14.4.636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 08/02/2012] [Indexed: 11/29/2022] Open
Abstract
The Angio-Seal is a widely used arterial closure device that helps achieve faster hemostasis and provide early ambulation to patients. However, it can cause various complications in clinical practice. We present the uncommon complication of popliteal artery occlusion following Angio-Seal deployment, and describe an effective interventional approach to its treatment. Because fluoroscopy-guided Fogarty embolectomy has the advantages of complete removal of the embolus without fragmentation, and clear visualization of the exact location of the embolus during the procedure, it is a suitable method for treating this complication.
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Affiliation(s)
- Doran Hong
- Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan 425-707, Korea
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6
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Dattilo PB, Tsai TT, Kevin Rogers R, Casserly IP. Acute and medium-term outcomes of endovascular therapy of obstructive disease of diverse etiology of the common femoral artery. Catheter Cardiovasc Interv 2013; 81:1013-22. [DOI: 10.1002/ccd.24475] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/05/2012] [Indexed: 11/10/2022]
Affiliation(s)
| | - Thomas T. Tsai
- Denver Veterans Administration Medical Center; Denver; Colorado
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7
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Treatment of infected pseudoaneurysm of femoral artery after vascular closure device deployment: a practical solution. Case Rep Vasc Med 2012; 2012:292945. [PMID: 23119221 PMCID: PMC3483687 DOI: 10.1155/2012/292945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 09/30/2012] [Indexed: 11/18/2022] Open
Abstract
Like other invasive procedures, percutaneous coronary interventions are associated with complications. Most common access site for these procedures is common femoral artery. Complications such as groin and retroperitoneal hematoma can be encountered as well as pseudoaneurysms, arteriovenous fistulas, acute arterial occlusion, and infection. When infected pseudoaneurysm occurs, surgical treatment can be extremely difficult. We present a case of the patient in whom infected pseudoaneurysm of common femoral artery developed after percutaneous coronary intervention and was successfully treated by surgical excision and autoarterial graft insertion.
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Sarin SN, Shah RK, Chun A, Akman A, Arora S, Rahbar R, Neville R, Venbrux AC. Use of the 8-F Angio-Seal Vascular Closure Device in Large-Caliber Arteriotomies. J Endovasc Ther 2012; 19:497-500. [DOI: 10.1583/12-3881.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Georg Y, Thaveau F, Lejay A, Bajcz C, Bakassa S, Chakfe N, Kretz JG. Arterial thrombosis after using Angio-Seal. Ann Vasc Surg 2012; 25:1078-93. [PMID: 22023942 DOI: 10.1016/j.avsg.2010.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 10/04/2010] [Accepted: 11/09/2010] [Indexed: 12/17/2022]
Abstract
Percutaneous closure systems of arterial puncture sites are being used more and more in modern endovascular practice. In this article, we report five cases of thrombotic complications following Angio-Seal deployment which required to be treated in our department between June 2004 and January 2006. We carried out a computerized literature review using "vascular closure" as a keyword and elected 106 articles published between 1992 and 2007. The analysis of this literature review showed that the rate of percutaneous closure complications was similar to the rate of manual compression complications, which is still the reference method. The complications associated with the use of these systems were more complex and more often required surgical repair. The severity and frequency of these complications differ based on the type of closure systems. The vascular surgeon in charge must have a good knowledge of these systems and of the complications each of them entails to be able to treat them in the most appropriate way.
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Affiliation(s)
- Yannick Georg
- Service de Chirurgie Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
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10
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Klocker J, Gratl A, Chemelli A, Moes N, Goebel G, Pachinger O, Jaschke W, Fraedrich G. Incidence and treatment of local stenosis or occlusion at the vascular access site leading to limb ischemia and new-onset intermittent claudication after percutaneous interventions: Implications of Vascular Closure Devices. Catheter Cardiovasc Interv 2011; 79:938-43. [DOI: 10.1002/ccd.23151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/19/2011] [Indexed: 01/02/2023]
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11
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Siani A, Accrocca F, Gabrielli R, Antonelli R, Giordano AG, Ambrogi C, Marcucci G. Management of acute lower limb ischemia associated with the Angio-Seal arterial puncture closing device. Interact Cardiovasc Thorac Surg 2011; 12:400-3. [DOI: 10.1510/icvts.2010.252486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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12
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Lombardo A, van den Berg JC. Preventing vascular access site complications during interventional procedures. Interv Cardiol 2010. [DOI: 10.2217/ica.10.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Das R, Ahmed K, Athanasiou T, Morgan RA, Belli AM. Arterial Closure Devices Versus Manual Compression for Femoral Haemostasis in Interventional Radiological Procedures: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2010; 34:723-38. [DOI: 10.1007/s00270-010-9981-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 07/27/2010] [Indexed: 11/28/2022]
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Endovascular Treatment of Complications of Femoral Arterial Access. Cardiovasc Intervent Radiol 2010; 33:457-68. [PMID: 20162284 DOI: 10.1007/s00270-010-9820-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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15
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Hon L, Ganeshan A, Thomas S, Warakaulle D, Jagdish J, Uberoi R. An overview of vascular closure devices: What every radiologist should know. Eur J Radiol 2010; 73:181-90. [DOI: 10.1016/j.ejrad.2008.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/21/2008] [Accepted: 09/23/2008] [Indexed: 11/28/2022]
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16
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Barbieux M, Tremel F, Epaulard O, Vitrat-Hincky V, Roch N, Bonadona A, Brion JP, Stahl JP, Pavese P. [Severe infection following arteriotomy with Angio-Seal]. Med Mal Infect 2009; 40:292-5. [PMID: 19616393 DOI: 10.1016/j.medmal.2009.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 03/07/2009] [Accepted: 06/04/2009] [Indexed: 11/25/2022]
Abstract
Diagnostic or interventional femoral artery catheterizations are more and more commonly practiced, so are haemostatic puncture closure devices, used to prevent bleeding complications and decrease hospital length of stay. Complications, such as infections, have been reported after using haemostatic puncture closure devices. We report the case of a female patient presenting with severe infection after Angio-Seal use: femoral artery infection with sepsis and multiple organ failure, septic embolism with embolic skin abscesses, bacterial arthritis and inferior limb necrosis. Studies comparing the infectious risk of manual compression versus haemostatic puncture closure devices are contradictory. Nevertheless, aseptic rules must be strictly observed. Indications for these devices concern only patients with high risk of hemorrhage and should be discussed for immunodepressed, diabetic, or obese patients.
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Affiliation(s)
- M Barbieux
- Service des maladies infectieuses, hôpital Michallon, CHU de Grenoble, 38043 Grenoble, France
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17
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Infectious Complications After the Use of Angioseal Closure Device for Femoral Artery. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e31817eec57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Chan YC, Morales JP, Reidy JF, Taylor PR. Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract 2008; 62:1604-13. [PMID: 17949429 DOI: 10.1111/j.1742-1241.2007.01494.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Retroperitoneal haematoma is a rare clinical entity with variable aetiology, which is increasing in incidence mainly due to complications related to interventional procedures. There is no general consensus as to the best management plan for patients with retroperitoneal haematoma. METHODS A literature review was undertaken using MEDLINE, all relevant papers on retroperitoneal haemorrhage or haematoma were used. RESULTS The diagnosis is often delayed as symptoms are nonspecific. Retroperitoneal haematoma should be suspected in patients with significant groin, flank, abdominal, back pain or haemodynamic instability following an interventional procedure. Spontaneous haemorrhage usually occurs in patients who are anticoagulated. Multi-slice CT and arteriography are important for diagnosis. Most haemodynamically stable patients can be managed with fluid resuscitation, correction of coagulopathy and blood transfusion. Endovascular treatment involving selective intra-arterial embolisation or the deployment of stent-grafts over the punctured vessel is attaining an increasingly important role. Open repair of retroperitoneal bleeding vessels should be reserved for cases when there is failure of conservative or endovascular measures to control the bleeding. Open repair is also required if endovascular facilities or expertise is unavailable and in cases where the patient is unstable. If treated inappropriately, the mortality of patients with retroperitoneal haematoma remains high. CONCLUSION There is a lack of level I evidence for the best management plans for retroperitoneal haematoma, and evidence is based on small cohort series or isolated case reports. Conservative management should only be reserved for patients who are stable. Interventional radiology with intra-arterial embolisation or stent-grafting is the treatment of choice. Open surgery is now rarely required.
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Affiliation(s)
- Y C Chan
- Department of Vascular & Endovascular Surgery, Guy's & St Thomas' NHS Foundation Hospital, St. Thomas' Hospital, London, UK
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Choi YH, Namgung J, Choe H, Kwon SU, Doh JH, Lee SY, Kim CY, Chang WI, Lee WR. Three Cases of Arterial Occlusion That Occurred After the Use of Angioseal®. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.6.339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yun-Ho Choi
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - June Namgung
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Hyunmin Choe
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Sung Uk Kwon
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Joon Hyung Doh
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Chang Young Kim
- Department of Thoracic and Cardiovascular Surgery, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Woo-Ik Chang
- Department of Thoracic and Cardiovascular Surgery, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Won Ro Lee
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea
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Schumacher PM, Ross CB, Wu YC, Donahue RM, Ranval TJ, Dattilo JB, Guzman RJ, Naslund TC. Ischemic complications of percutaneous femoral artery catheterization. Ann Vasc Surg 2007; 21:704-12. [PMID: 17980794 DOI: 10.1016/j.avsg.2007.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 04/02/2007] [Accepted: 05/30/2007] [Indexed: 11/19/2022]
Abstract
Ischemic injuries following percutaneous femoral artery catheterization are uncommon but have been associated with vascular closure devices (VCDs). The purpose of this study was to retrospectively compare ischemic and hemorrhagic complications of femoral artery catheterization and to identify factors associated with ischemic injuries. The operative registries of the attending vascular surgeons at one academic and two community hospitals were retrospectively reviewed to identify all complications of femoral artery catheterization requiring operative intervention. Demographic, clinical, procedural, operative, and outcome data were compared between patients who sustained ischemic and hemorrhagic complications. From January 2001 to December 2006, 95 patients required operative management of complications related to femoral artery catheterization including 40 patients who experienced ischemic (group 1) and 55 patients who experienced hemorrhagic (group 2) complications. Compared to those sustaining hemorrhagic complications, ischemic complications were more frequently associated with younger age, smoking, VCD deployment, and, when controlling for VCD use, female gender. Time to presentation was also significantly longer in patients experiencing ischemic complications. Ischemic complications are increasingly recognized following femoral artery catheterization. Vascular surgeons should anticipate a new pattern of injury following femoral artery catheterization, one that often requires complex arterial reconstruction.
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Affiliation(s)
- Paul M Schumacher
- Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2735, USA
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21
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Gargiulo NJ, Veith FJ, Ohki T, Scher LA, Berdejo GL, Lipsitz EC, Menegus M, Greenberg M. Histologic and duplex comparison of the perclose and angio-seal percutaneous closure devices. Vascular 2007; 15:24-9. [PMID: 17382051 DOI: 10.2310/6670.2007.00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The intravascular and extravascular effects of percutaneous closure devices have not been well studied. We assessed the performance and healing characteristics in dogs of two devices approved by the US Food and Drug Administration. Nine adult male dogs were anesthesized prior to percutaneous access of both femoral arteries with a 6F sheath. All dogs were systemically heparinized to an activated clotting time (ACT) > 250 seconds. Duplex sonography was performed preoperatively to measure vessel diameter and flow velocity. In each dog, one of two devices (Perclose, Abbot Laboratories, Abbott Park, IL or Angio-Seal, St. Jude Medical, St. Paul, MN) was randomly deployed into one of the two femoral arteries. The other device was deployed on the opposite side. Duplex sonography was repeated immediately after deployment and 28 days later to measure changes in vessel diameter and flow velocity. At 28 days, angiography was performed on both femoral arteries before they were removed for histologic evaluation. The time required to excise each vessel reflected the degree of scarring. Hemostasis time for the Angio-Seal device far surpassed the Perclose device (39 +/- 7 vs 0 minutes; p < .05). Vessel narrowing was observed only at 28 days after deployment of the Angio-Seal device (p < .05). Extensive extravascular scarring was observed with the Angio-Seal device, which resulted in a longer femoral artery dissection time and greater periadventitial scar thickness compared with the Perclose device (p < .05). When compared with the Perclose suture closure device, the Angio-Seal collagen plug closure device prolonged hemostasis time and produced greater vessel narrowing and periadventitial inflammation (extravascular scarring) in a canine model at 4 weeks.
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Affiliation(s)
- Nicholas J Gargiulo
- Division of Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 20th Street, Bronx, NY 10467, USA.
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22
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Klein AJ, Messenger JC, Casserly IP. Contemporary management of acute lower extremity ischemia following percutaneous coronary and cardiac interventional procedures using femoral access--a case series and discussion. Catheter Cardiovasc Interv 2007; 70:129-37. [PMID: 17585383 DOI: 10.1002/ccd.21158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
New onset of acute lower extremity ischemia following percutaneous coronary and cardiac interventional procedures using femoral access is an important clinical entity that requires emergent assessment to determine the precise etiology and institute appropriate therapy. We report four cases of this clinical event from our catheterization laboratories that serve to highlight the most frequent etiologies, the importance of immediate diagnostic angiography, and the potential for endovascular techniques to effectively manage this complication.
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Affiliation(s)
- Andrew J Klein
- University of Colorado Health Sciences at Denver, Denver, Colorado 80262, USA
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23
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Siani A, Siani LM, Marcucci G, Mounayergi F, Baldassarre E. Regarding "Angio-Seal arterial puncture closing device removal: some technical details". J Vasc Surg 2007; 46:399-400; author reply 400. [PMID: 17664121 DOI: 10.1016/j.jvs.2007.03.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 03/11/2007] [Indexed: 11/22/2022]
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Alconero Camarero AR, Casáus Pérez M, Mirones Valdeolivas LE, García Zarrabeitia MJ, García Campo ME, Pérez Bolado C. [Descriptive study of vascular complications secondary to antithrombotic agents and percutaneous cardiovascular interventionism in a coronary unit]. ENFERMERIA INTENSIVA 2006; 17:96-103. [PMID: 17020742 DOI: 10.1016/s1130-2399(06)73922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Administration of drugs in the patients diagnosed of acute coronary syndrome and treated with percutaneous transluminal coronary angioplasty (PTCA) has noticeably reduced morbidity-mortality and appearance of new ischemic events. However, these drug agents may cause bleeding problems secondary to therapeutic intervention. The objectives of this research are: to know the incidence of vascular complications developed in patients treated with antithrombotic drugs and percutaneous cardiovascular interventionism and describe variables that may be related with their appearance. A retrospective descriptive study was done on the registries of the clinical histories of 153 patients subjected to primary angioplasty and rescue treatment during the period ranging from October 1, 2001 to October 31, 2002 in the Hospital Universitario Marques de Valdecilla. Mean age of the patients was 63 years, 75% diagnosed of acute myocardial infarction and 71% subjected to primary angioplasty. Drugs used were anticoagulants, antiaggregants and fibrinolytics. Furthermore compression methods and arterial sheath duration time were analyzed. Complications appeared in 39% of the patients, the most frequent complication being the hematoma in 28%. It is concluded that when antithrombotic drugs are combined with PTCA, vascular complications appear in one third of the patients studied, the appearance of hematomas standing out in the first place and in the second place, femoral bleeding. The main study variables also contributing to their appearance are the permanence of the sheath and its removal.
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Affiliation(s)
- Ana Rosa Alconero Camarero
- Escuela Universitaria de Enfermería Casa de Salud Valdecilla, Universidad de Cantabria, Santander, España.
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Abstract
Improvements in surgical technique, advances in the field of immunosuppresion and the early diagnosis and treatment of complications related to liver transplantation have all led to prolonged survival after liver transplantation. In particular, advances in diagnostic and interventional radiology have allowed the Interventional Radiologist, as part of the transplant team, to intervene early in patients presenting with complications related to organ transplant with resultant increase in graft and patient survival. Such interventions are often achieved using minimally invasive percutaneous endovascular techniques. Herein we present an overview of some of these diagnostic and therapeutic approaches in the treatment and management of patients before and after liver transplantation.
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Affiliation(s)
- Nikhil B Amesur
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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26
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Mlekusch W, Dick P, Haumer M, Sabeti S, Minar E, Schillinger M. Arterial Puncture Site Management After Percutaneous Transluminal Procedures Using a Hemostatic Wound Dressing (Clo-Sur P.A.D.) Versus Conventional Manual Compression:A Randomized Controlled Trial. J Endovasc Ther 2006; 13:23-31. [PMID: 16445320 DOI: 10.1583/05-1679.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the efficacy and safety of a novel hemostatic wound dressing designed for rapid hemostasis at arterial puncture sites. METHODS Over a 15-month period, 209 consecutive patients were randomized to conventional manual compression (n=105) or the use of the Clo-Sur P.A.D. hemostatic device (n=104) after removal of the sheath. Puncture-related and device-related complications, time to hemostasis, time to ambulation, and patient and physician discomfort were recorded. RESULTS In 209 patients, 21 (10.0%) puncture-related complications were observed, including 11 (5.3%) pseudoaneurysms, 9 (4.3%) hematomas, and 1 (0.5%) major bleeding complication. There was no significant difference (p=0.36) in complications between the hemostatic device (9/104, 8.7%) and the conventional group (12/105, 11.4%). In the hemostatic device group compared to the conventional group, respectively, the average time to hemostasis (13.6 versus 20.3 minutes; p<0.001), time to ambulation (6.5 versus 17.4 hours, p<0.001), patient discomfort (VAS 2.1 versus 4.7, p<0.001), and physician discomfort (VAS 3.8 versus 5.2, p<0.001) were significantly lower. Twenty (19%) sheath removals in the hemostatic device group were classified as a technical failure of the device. CONCLUSION The use of this hemostatic wound dressing for arterial access site management after percutaneous vascular procedures significantly reduced the time to hemostasis, enabled early mobilization, and reduced patient discomfort without increasing the risk for complications compared to conventional manual compression. A high rate of technical failures, however, warrants further improvement before routine use can be recommended.
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Affiliation(s)
- Wolfgang Mlekusch
- Department of Angiology, Vienna General Hospital, Medical School, Vienna, Austria.
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27
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Jang JJ, Kim M, Gray B, Bacharach JM, Olin JW. Claudication secondary to Perclose use after percutaneous procedures. Catheter Cardiovasc Interv 2006; 67:687-95. [PMID: 16586517 DOI: 10.1002/ccd.20646] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The use of suture-mediated arterial closure devices has dramatically increased with the increased number of percutaneous procedures being performed. Complications from suture-mediated closure devices have been underreported. Specifically, arterial stenosis resulting in claudication has not been previously described in detail. We present nine patients who presented with various leg symptoms after Perclose was used to achieve arterial hemostasis following percutaneous procedures. All cases were found to have significant arterial stenoses from the Perclose sutures. Once diagnosis was correctly made, the patients either underwent surgical repair or percutaneous balloon angioplasty and in all cases the symptoms abated.
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Affiliation(s)
- James J Jang
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York 10029, USA
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Mukhopadhyay K, Puckett MA, Roobottom CA. Efficacy and complications of Angioseal in antegrade puncture. Eur J Radiol 2005; 56:409-12. [PMID: 16298678 DOI: 10.1016/j.ejrad.2005.03.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 03/07/2005] [Accepted: 03/09/2005] [Indexed: 11/29/2022]
Abstract
AIM Although arterial closure devices are in use for over a decade, there have been no specific study to assess the use of the same in antegrade puncture. MATERIAL AND METHOD Consecutive patients undergoing antegrade puncture for peripheral vascular disease in a single centre performed by a single operator were included in this study. The notes and the angiograms were reviewed retrospectively for possible complications and the severity of disease. RESULT Over a 25-month period, 21 patients with antegrade puncture had Angioseal deployed for haemostasis. Post-procedure complications recorded from the case notes showed one episode of haematoma formation and one case of worsening ischaemia. The severity of the disease at the puncture site did not influence the outcome. CONCLUSION Use of Angioseal is safe and effective in antegrade punctures for peripheral vascular disease. The result is independent of the severity of disease at the puncture site.
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29
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Hamner JB, Dubois EJ, Rice TP. Predictors of Complications Associated With Closure Devices After Transfemoral Percutaneous Coronary Procedures. Crit Care Nurse 2005. [DOI: 10.4037/ccn2005.25.3.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Jenny B. Hamner
- Jenny B. Hamner is an associate professor and assistant dean at Auburn University School of Nursing, Auburn, Ala
| | - E. Jean Dubois
- E. Jean Dubois is an assistant professor at Auburn University School of Nursing and the clinical liaison to East Alabama Medical Center, Opelika, Ala
| | - Tanya P. Rice
- Tanya P. Rice is the cardiology case manager at East Alabama Medical Center
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30
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Starnes BW, O'Donnell SD, Gillespie DL, Goff JM, Rosa P, Parker MV, Chang A. Percutaneous arterial closure in peripheral vascular disease: a prospective randomized evaluation of the Perclose device. J Vasc Surg 2003; 38:263-71. [PMID: 12891107 DOI: 10.1016/s0741-5214(03)00291-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with peripheral vascular disease have been excluded from initial studies of percutaneous suture-mediated closure devices (SMCD) despite representing a significant proportion of those requiring endovascular intervention. We sought to determine whether these devices could be safely used in patients with peripheral vascular disease. METHODS Patients were stratified into two groups and five subgroups on the basis of indication for arteriography, and they were prospectively randomized at the end of the procedure to receive either the SMCD or manual compression. Ankle-brachial index was determined and duplex ultrasound scanning of the accessed femoral artery was performed, before and after the procedure. Ultrasound data included peak systolic velocity, minimum intraluminal vessel diameter, and presence or absence of calcified plaque. Time to hemostasis, ambulation, and discharge were recorded, and major or minor complications were noted. RESULTS Of 102 patients included in the study, 52 patients were randomized to receive the SMCD. There was no difference in ankle-brachial index, minimum intraluminal vessel diameter, or peak systolic velocity in the accessed vessel after closure with SMCD or manual compression. Time to hemostasis, ambulation, and discharge was significantly less in the SMCD group (P =.001). Presence of calcified plaque was not associated with complications (P =.146). In the SMCD group, hemostasis was achieved with 49 of 52 devices (94.2%). There were six complications (5.9%), two of which were major and required operative intervention. All complications were hemorrhagic and not occlusive. There was no difference in overall complication rate between SMCD (7.7%) and manual compression (4.0%) groups (P =.678). No infection was noted in any of the 102 patients. CONCLUSIONS Suture-mediated percutaneous arterial closure can be safely performed in patients with peripheral vascular disease, even in the presence of calcified plaque. This closure technique enables shorter time to hemostasis, ambulation, and hospital discharge. There are observed differences in minor, but not major, complication rates for MC versus percutaneous arterial closure in patients with peripheral vascular disease, but these differences did not achieve statistical significance in this small series.
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Affiliation(s)
- B W Starnes
- Peripheral Vascular Surgery Clinic W64, Walter Reed Army Medical Center, 6400 Georgia Avenue NW, Washington, DC 20854, USA.
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31
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Rilling WS, Dicker M. Arterial puncture closure using a collagen plug, I. (Angio-Seal). Tech Vasc Interv Radiol 2003; 6:76-81. [PMID: 12903000 DOI: 10.1053/tvir.2003.36448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Closure devices can generally be categorized by their mechanism of obtaining hemostasis. Currently, devices are either suture-based, collagen-based, or utilize a combination of technologies. They can also be classified on the basis of whether or not they have an intravascular component or exclusively extra-vascular components. The devices that are currently available differ markedly in their mechanism of action, deployment, advantages, and disadvantages. In this article, we will review in detail the Angio-Seal closure device, review some of the current literature regarding this device, and assess its complications, advantages, and disadvantages.
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Affiliation(s)
- William S Rilling
- Section of Vascular/Interventional Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, WI 53226, USA
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32
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Affiliation(s)
- Daniel B Brown
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, Missouri 63110, USA.
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33
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Pullen AJ, Carrell TWG, Wilkins CJ, Sayer GL, Edmondson RA. Percutaneous closure devices in synthetic graft punctures: a case for concern? Eur J Vasc Endovasc Surg 2002; 24:545-6. [PMID: 12443753 DOI: 10.1053/ejvs.2002.1745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A J Pullen
- Department of Vascular Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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34
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Eggebrecht H, Haude M, Woertgen U, Schmermund A, von Birgelen C, Naber C, Baumgart D, Kaiser C, Oldenburg O, Bartel T, Kroeger K, Erbel R. Systematic use of a collagen-based vascular closure device immediately after cardiac catheterization procedures in 1,317 consecutive patients. Catheter Cardiovasc Interv 2002; 57:486-95. [PMID: 12455083 DOI: 10.1002/ccd.10254] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite recent advances in interventional cardiology, vascular access complications continue to be a significant problem. Conventional manual compression of the femoral access site is associated with prolonged immobilization and significant patient discomfort. We investigated the performance of a collagen-based closure device applied immediately after catheterization and its complication rate in 1,317 consecutive patients undergoing cardiac catheterization or coronary angioplasty. Patients undergoing coronary angioplasty (n = 644) received more heparin than patients with diagnostic cardiac catheterization (n = 673; 9,675 +/- 1,144 IU vs. 6,419 +/- 2,211 IU; P < 0.0001). Deployment success rates of the closure device were comparable for patients undergoing diagnostic vs. interventional procedures (95.8% vs. 96.7%; P = 0.46). Complete hemostasis immediately after deployment of the device was achieved in > 90% of all patients, but was lower in the interventional group (93.7% vs. 90.6%; P = 0.05). Major complications including any vascular surgery, major bleeding requiring transfusion, retroperitoneal hematoma, thrombosis or loss of distal pulses, groin infections, significant groin hematoma, and death were observed in 0.53% of all patients, with no differences between diagnostic or interventional patients (0.62% vs. 0.45%; P = 0.953). Subgroup analysis revealed female gender as a predictor of access site complications. Systematic sealing of femoral access sites after both diagnostic and interventional procedures allows for immediate sheath removal with reliable hemostasis. The use of a collagen-based closure device is associated with a low rate of clinically significant complications.
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Affiliation(s)
- Holger Eggebrecht
- Department of Cardiology, Center of Internal Medicine, University Hospital Essen, Essen, Germany.
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35
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Brown DB, Crawford ST, Norton PL, Hovsepian DM. Angiographic follow-up after suture-mediated femoral artery closure. J Vasc Interv Radiol 2002; 13:677-80. [PMID: 12119324 DOI: 10.1016/s1051-0443(07)61843-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Percutaneous closure devices are used in as many as 30% of all endovascular studies. Despite widespread use of these devices, only limited imaging has been performed after percutaneous closure. In this study, arteriograms of patients who had undergone suture-mediated closure with the Perclose device were reviewed. MATERIALS AND METHODS Between June 1998 and November 2001, 31 patients who had previously undergone closure with use of the Perclose device at our institution returned for additional angiographic procedures. Twenty-one patients underwent closure with use of the Perclose device after embolization, including hepatic artery chemoembolization (n = 18), treatment of hypervascular sacral metastases (n = 2), and bronchial artery embolization (n = 1). Nineteen of these patients had thrombocytopenia. Ten patients underwent closure with use of the Perclose device after diagnosis and treatment of peripheral vascular disease. RESULTS Of 31 patients, 28 had normal follow-up studies, including one patient who underwent four previous closures. These 28 patients all had normal femoral artery caliber at initial angiography and a platelet count of more than 18,000/mm(3). Two patients with preexisting atherosclerotic change had progression of disease at the puncture site and a third with severe thrombocytopenia developed a small asymptomatic posterolateral pseudoaneurysm. CONCLUSION In patients with normal femoral arteries, the long-term effects of closure with use of the Perclose device, even performed multiple times, appears to be minimal.
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Affiliation(s)
- Daniel B Brown
- Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 South Kingshighway Boulevard, St. Louis, Missouri 63110, USA.
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36
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Wallace MJ, Ahrar K. Percutaneous closure of a subclavian artery injury after inadvertent catheterization. J Vasc Interv Radiol 2001; 12:1227-30. [PMID: 11585892 DOI: 10.1016/s1051-0443(07)61685-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Life-threatening complications of subclavian central venous access are rare. Herein a case of inadvertent subclavian artery catheterization and subsequent percutaneous arterial repair with use of the Prostar XL suture-mediated closure device and temporary balloon tamponade is reported. This approach obviated a complex surgical intervention that would have required medial clavicle resection.
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Affiliation(s)
- M J Wallace
- University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 325, Houston, Texas 77030-4009, USA.
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37
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Cherr GS, Travis JA, Ligush J, Plonk G, Hansen KJ, Braden G, Geary RL. Infection is an unusual but serious complication of a femoral artery catheterization site closure device. Ann Vasc Surg 2001; 15:567-70. [PMID: 11665443 DOI: 10.1007/s10016-001-0002-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Percutaneous devices have been developed to close the femoral artery puncture site after catheterization. Because direct compression is not needed, the devices save time for the treating health-care provider, reduce patient discomfort, and obviate the need for post-catheterization bed rest. Reported complications with use of these devices are similar in nature and frequency to those accompanying direct compression. Complications of infection requiring surgical treatment are exceedingly rare with use of these devices. We describe a series of five catheterization site infections occurring among 1807 patients (0.3%) whose femoral artery puncture was closed with a percutaneous suture closure device. All patients required operative intervention and there was one late death. Physicians should be aware of this uncommon but serious complication to expedite evaluation and treatment of patients with suspected infections from these devices.
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Affiliation(s)
- G S Cherr
- Department of General Surgery, Section on Vascular Surgery, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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38
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Toursarkissian B, Mejia A, Smilanich RP, Shireman PK, Sykes MT. Changing patterns of access site complications with the use of percutaneous closure devices. VASCULAR SURGERY 2001; 35:203-6. [PMID: 11452346 DOI: 10.1177/153857440103500307] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report their experience with 15 cases of groin complications associated with the use of percutaneous closure devices following femoral arterial catheterization over a 2-year period. The complication rate was 1.7% for catheterizations in which a closure device was used. The 15 cases included 7 uncomplicated pseudoaneurysms (PSA), 3 infected pseudoaneurysms, 4 nonarterial groin infections (infected hematomas and/or abscesses), and 1 case of femoral artery occlusion. These complications presented at an average of 5 +/- 4 days postcatheterization. One patient with an infected PSA required a below-the-knee amputation. During the same time interval, there were no infectious complications in patients not receiving closure devices. We conclude that groin complications associated with such devices tend to present late and include a higher percentage of infections as opposed to complications occurring in patients not receiving closure devices. An aggressive surgical approach to these problems appears warranted.
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Affiliation(s)
- B Toursarkissian
- Section of Vascular Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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39
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Nehler MR, Lawrence WA, Whitehill TA, Charette SD, Jones DN, Krupski WC. Iatrogenic vascular injuries from percutaneous vascular suturing devices. J Vasc Surg 2001; 33:943-7. [PMID: 11331832 DOI: 10.1067/mva.2001.115002] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the patterns of injury and the strategies of surgical repair of iatrogenic vascular injuries from a percutaneous vascular suturing device after arterial cannulation. METHODS We retrospectively reviewed the clinical experience from an academic vascular surgical practice over a 2-year period. The subjects were patients undergoing vascular repair of iatrogenic vascular injury after deployment of a percutaneous vascular suturing device. Interventions were direct repair of arterial injury (with or without device extraction) or arterial thrombectomy and repair. The main outcome variables included patterns of arterial injury, magnitude of arterial repair, limb salvage, hospital stay, and perioperative mortality and morbidity rates. RESULTS From August 1998 through August 2000, eight patients (4 men, 4 women; median age, 55 years; range, 44-80 years) required vascular operations for complications of percutaneous suturing devices after diagnostic (2) or therapeutic (6) arteriograms through a transfemoral approach. Complications included four pseudoaneurysms (1 infected) due to arterial tear from suture pull through, two entrapped closure devices due to device malfunction, and two arterial thromboses due to narrowing/severe intimal dissection. All patients required operative intervention. Direct suture repair with or without device removal was performed in five patients, arterial debridement with vein patch angioplasty in one patient, and arterial thrombectomy and vein patch angioplasty in two patients. There were no perioperative deaths. The median hospital stay was 5 days (range, 2-33). Limbs were salvaged in all patients with a mean follow-up of 4.8 months (range, 1-13). CONCLUSIONS Although abbreviated postangiography recovery periods and early ambulation have motivated the widespread use of percutaneous suturing devices, the infrequent occurrence of vascular injuries produced by these devices can be significantly more challenging than simple acute pseudoaneurysms or hemorrhage. In addition, thrombotic complications have a small but finite risk of limb loss.
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Affiliation(s)
- M R Nehler
- Division of Vascular Surgery, Department of Surgery, University of Colorado Health Sciences Center, Denver 80262-0312, USA.
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40
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Sprouse LR, Botta DM, Hamilton IN. The management of peripheral vascular complications associated with the use of percutaneous suture-mediated closure devices. J Vasc Surg 2001; 33:688-93. [PMID: 11296318 DOI: 10.1067/mva.2001.112324] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study is to identify the peripheral vascular complications associated with the use of percutaneous suture-mediated closure (PSMC) devices and compare them with postcatheterization femoral artery complications not associated with PSMC devices. METHODS This is a retrospective review of all patients admitted to the vascular surgery service at the Chattanooga Unit of the University of Tennessee Department of Surgery with a peripheral vascular complication after percutaneous femoral arteriotomy between July 1, 1998, and December 1, 1999. The complications followed the use of PSMC devices (group I, n = 11) and traditional compression therapy (group II, n = 14) to achieve arterial hemostasis. Group II was subdivided into patients who required operative intervention (group IIA, n = 8), and those who were treated without operation (group IIB, n = 6). RESULTS No significant difference was found between groups I and II with regard to age (P =.227), time to vascular surgery consultation (P =.987), or diagnostic versus therapeutic catheterization (P =.897). A significant difference was found with regard to mean pseudoaneurysm size (group I = 5.9 cm, group II 2.9 cm; P =.003). Ultrasound compression was successfully performed in 66.6% of group II patients, but no (0.0%) patient in group I responded to this therapy (P =.016). Groups I and IIA had a significant difference for mean estimated blood loss (group I = 377.2 mL, group II = 121.8 mL; P =.017) and requirement for transfusion (P =.013). More patients in group I required extensive surgical treatment (P =.007), with six of these patients requiring vein patch angioplasty during their treatment. More patients in group I also had infectious complications (n = 3) compared with group IIA (n = 1). CONCLUSION In comparison with complications that follow percutaneous arteriotomy when PSMC devices are not used for hemostasis: (1) pseudoaneurysms after the use of PSMC devices are larger and do not respond to ultrasound compression, (2) complications associated with PSMC devices result in more blood loss and increased need for transfusion and are more likely to require extensive operative procedures, and (3) arterial infections after the use of PSMC devices are more common and require aggressive surgical management.
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Affiliation(s)
- L R Sprouse
- University of Tennessee College of Medicine, Chattanooga Unit, Department of Surgery, USA
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41
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Abstract
Groin complications after cardiac catheterizations are common. With the increasing use of mechanical hemostatic devices, cardiologists must be alert to a wide array of potential problems. We report an unusual complication after the use of a closure device.
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Affiliation(s)
- A Tuli
- Emory University School of Medicine, Atlanta, Georgia 30322, USA
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42
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Rilling WS. A Clean Finish: Closure Devices. J Vasc Interv Radiol 2001. [DOI: 10.1016/s1051-0443(01)70056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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43
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Criado FJ, Abul-Khoudoud O, Martin JA, Wilson EP. Current developments in percutaneous arterial closure devices. Ann Vasc Surg 2000; 14:683-7. [PMID: 11128469 DOI: 10.1007/s100169910123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F J Criado
- Center for Vascular Intervention, Union Memorial Hospital/MedStar Health, Baltimore, MD, USA
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44
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Eggebrecht H, Haude M, Baumgart D, Oldenburg O, Herrmann J, Bruch C, Hunold P, Neurohr C, von Birgelen C, Welge D, Katz MA, Erbel R. [Hemostatic closure of arterial puncture site using Angio-Seal after diagnostic heart catheterization or coronary intervention]. Herz 1999; 24:607-13. [PMID: 10652673 DOI: 10.1007/bf03044484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Conventional manual compression and subsequent application of pressure bandages is associated with prolonged immobility and significant patient discomfort. Routine anticoagulation as well as the use of new interventional devices and platelet inhibiting strategies lead to a higher incidence of local bleeding complications after diagnostic cardiac catheterization or coronary angioplasty. Immediate sheath removal increases patient comfort. The Angio-Seal system uses a biodegradable anchor and collagen plug for sealing of arterial puncture sites. Several studies showed the safety and efficacy of this device. Technical deployment success ranges between 88 and 100%. Significant reduction in time to hemostasis allows for earlier patient ambulation and shorter in-hospital stay compared to manual compression with peripheral complications not being increased.
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Affiliation(s)
- H Eggebrecht
- Abteilung für Kardiologie, Zentrum für Innere Medizin, Universitätsklinikum Essen.
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