Could real-time ultrasonography guidance be useful for the effective deployment of FemoSeal in common femoral arteriotomy?

Ultrasound-guided Femoseal® vascular closure device in antegrade common femoral artery puncture

AIM

To retrospectively review the efficacy and safety of ultrasound-guided Femoseal vascular closure device in antegrade common femoral artery puncture after peripheral arteries revascularization.

METHODS

We reviewed the hemostatic outcome achieved with DUS guided FemoSeal in patients undergoing antegrade common femoral artery accesses for percutaneous lower limbs revascularization using 6- to 8-Fr vascular sheaths. Exclusion criteria were known bleeding or coagulation disorder, previous femoral artery punctures within 1 month and/or previous common femoral artery vascular interventions. Primary endpoint was technical success. Secondary endpoints were access complications and need for reintervention.

RESULTS

A total of 301 patients (250 M; 51 F) were included in the study. Technical success was achieved in 99%. One pseudoaneurysm (0.3%) developed in the first post-operative day and was treated with Human Thrombin Injection. Two more pseudoaneurysms were found during follow-up at the first 1 month US scan. Two conversions to manual compression occurred.

CONCLUSION

The use of ultrasound-guided FemoSeal VCD in antegrade CFA puncture demonstrated high technical success and a low complication rate. These findings suggest that it is a safe and effective option for achieving hemostasis in patients undergoing percutaneous lower limb revascularization. Further studies with larger cohorts and longer follow-up may help confirm these results and refine patient selection criteria.

Ultrasonography-guided endovascular management of femoral artery pseudoaneurysm after unintended dialysis catheterization with suture-mediated vascular closure devices

Although iatrogenic pseudoaneurysm is an infrequent complication, it can be life threatening if ruptured. There are several treatment methods for managing this complication. This case report demonstrates a technique using ultrasonography-guided suture-mediated vascular closure devices without angiography to successfully treat iatrogenic superficial femoral pseudoaneurysm following an unintended hemodialysis catheter insertion. In particular, when it is difficult to use a contrast due to a patient's condition as in this case, suture-mediated vascular closure device with ultrasonography guidance can be used as a therapeutic method.

Imaging-Guided Deployment of a Balloon-Based Vascular Closure Device in Routine Clinical Practice

This study evaluated the feasibility and safety of imaging-guided deployment of a Mynx Control device (Cordis, Miami Lakes, Florida) at the femoral access. A total of 201 Mynx devices were used under imaging guidance in 137 patients (mean age, 64.18 years ± 13.8; male, 68.6%) between June 2020 and February 2022. A 5-F sheath was used in 176 (87.6%) procedures, a 6-F sheath was used in 17 (8.5%) procedures, and a 7-F sheath was used in 8 (4%) procedures. Indicator errors occurred in 9 (4.5%) procedures. However, technical success was achieved via manipulation under imaging guidance in all procedures. The mean time to hemostasis was 3.3 minutes ± 0.5, and the clinical success rate was 100%. The mean length of hospital stay was 7 days ± 7.5. After 4 (2%) procedures, small hematomas reabsorbed spontaneously. Imaging-guided deployment of a Mynx Control device is a feasible and safe option for access site closure. Even after an indicator error, successful hemostasis was achieved via real-time interaction.