Analysis of predictive and preventive factors for access complications associated with vascular closure devices in complicated endovascular procedures

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies. Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access

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Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention

10.2310/vasc.2387 ◽

2018 ◽

Author(s):

Lalithapriya Jayakumar ◽

Mark Davies

Keyword(s):

Lower Extremity ◽

Vascular Disease ◽

Endovascular Procedures ◽

Vascular Diseases ◽

Limb Ischemia ◽

Arterial Disease ◽

Surgical Approaches ◽

Acute Ischemia ◽

Acute Limb Ischemia ◽

Access Complications

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies. Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access

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Access Site Complications of Peripheral Endovascular Procedures: A Large, Prospective Registry on Predictors and Consequences

Journal of Endovascular Therapy ◽

10.1177/15266028211025044 ◽

2021 ◽

pp. 152660282110250

Author(s):

Andrei Ciprian Cacuci ◽

Hans Krankenberg ◽

Maja Ingwersen ◽

Mohamed Gayed ◽

Sven Daniel Stein ◽

...

Keyword(s):

Brachial Artery ◽

Prospective Observational Study ◽

Endovascular Procedures ◽

Advanced Age ◽

Puncture Site ◽

Access Site ◽

Arteriovenous Fistulas ◽

Female Sex ◽

Vascular Closure Devices ◽

Antithrombotic Medication

Purpose The purpose of this study was to investigate predictors and consequences of acute vascular access site complications (ASCs) related to peripheral endovascular diagnostic or interventional procedures. Despite improvement of puncture techniques, access site–related morbidity and mortality is still considerable. Materials and Methods A total of 5263 participants who underwent 5385 endovascular procedures at a single center were consecutively included in this prospective, observational study. Primary outcomes were ASCs defined as composite of puncture site hematoma, pseudoaneurysm, arteriovenous fistula, and overt puncture site bleeding on the first day after procedure. Results ASCs occurred in 16.6% of peripheral endovascular procedures (78.6% hematomas, 18.9% pseudoaneurysms, 1.4% arteriovenous fistulas, 1.1% overt bleedings). Independent predictors were advanced age [odds ratio (OR) per 10 years: 1.12, p=0.004], female sex (OR men, 0.77; p=0.001), lysis (OR 3.56; p<0.001), periprocedural heparin (OR 5000 IU, 1.96; p=0.001; OR >5000 IU, 3.56; p=0.02), time to access (OR per 10 seconds, 1.01; p<0.001), sheath size (OR per French, 1.59; p<0.001), brachial artery access (OR vs retrograde transfemoral, 4.58; p<0.001), and compression only (OR Angio-Seal, 0.57, p=0.02; ProGlide, 0.36, p<0.001; FemoSeal, 0.57, p<0.001). Treatment was required in 20.2% and prolonged hospitalization in 17.7% of ASC. Three participants died from access site–related bleeding. Conclusion ASCs after peripheral endovascular procedures are associated with advanced age, female sex, periprocedural antithrombotic medication, brachial artery access, postinterventional bleeding, and nonuse of vascular closure devices.

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Vascular Closure Devices after Endovascular Procedures in Swine: A Reliable Method?

The Scientific World JOURNAL ◽

10.1155/2014/514942 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

P. Isfort ◽

T. Tanaka ◽

T. Penzkofer ◽

P. Bruners ◽

R. Tolba ◽

...

Keyword(s):

Ct Angiography ◽

Femoral Artery ◽

Endovascular Procedures ◽

Initial Study ◽

Closure Device ◽

Technical Success Rate ◽

Chronic Group ◽

Vascular Closure Devices ◽

Acute Group ◽

The Sacrifice

Purpose. To investigate the safety and feasibility of the use of a vascular closure device (VCD) after endovascular procedures in swine.Material and Methods. In a study on endovascular therapy, VCD (StarClose, Abbott Vascular, Il, USA) was used in 20 female swines to achieve immediate hemostasis after percutaneous right femoral artery (FA) access. 10 animals were sacrificed immediately after the study and 10 animals were sacrificed 28 days after the initial study. To ensure complete hemostasis and patency of the femoral artery, a CT-angiography of the puncture site was performed on day 1 (acute and chronic group) and day 28 (chronic group). After the sacrifice, the femoral artery was explanted and examined macroscopically for signs of VCD dysfunction.Results. Technical success rate was 100% with immediate hemostasis being achieved in all animals. No animals showed evidence of hematoma. During explantation, only small traces of coagulated blood were found in the acute group, while there were no signs of hematoma in the chronic group. CT-angiography immediately after VCD application as well as before sacrifice (chronic group) showed patency of the FA in all cases.Conclusion. The use of VCD to achieve hemostasis after endovascular studies in swine is feasible and safe.

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Perclose ProGlide embolization as a complication: case report and review of literature

Future Cardiology ◽

10.2217/fca-2020-0154 ◽

2021 ◽

Author(s):

Larab L Giniyani ◽

Yesha P Rana ◽

Balaram Krishna J Hanumanthu ◽

Doris Chan ◽

Tak W Kwan

Keyword(s):

Aortic Aneurysm ◽

Endovascular Procedures ◽

Closure Device ◽

Mechanical Compression ◽

Review Of Literature ◽

Femoral Access ◽

Descending Aorta ◽

Infrarenal Aortic Aneurysm ◽

Important Complication ◽

Vascular Closure Devices

Background: Vascular closure devices have replaced mechanical compression for closure of femoral access sites after endovascular procedures. Case: We present an 87-year old male with symptomatic infrarenal aortic aneurysm measuring 4.8 cm presenting for elective endovascular repair of the aortic aneurysm. A Perclose ProGlide Suture-Mediated Closure was used for closure. The closure was complicated by a separation of the ProGlide device resulting in the migration of the footplate to the descending aorta. Correction required snare retrieval via radial access, and the patient recovered without complications. Discussion: We highlight an important complication of the Perclose ProGlide Suture-Mediated Closure device that is rare but important to know when performing endovascular closures with this device.

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A hybrid bleeding control method for retro-peritoneal or inguinal bleeding after endovascular procedures

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v1i1.31 ◽

2017 ◽

Vol 1 (1) ◽

pp. 34-38

Author(s):

Tal M Hörer ◽

Viktor Reva

Keyword(s):

Blood Loss ◽

Open Surgery ◽

Endovascular Procedures ◽

Surgical Repair ◽

Control Method ◽

Hybrid Technique ◽

Bleeding Control ◽

Open Surgical Repair ◽

Vascular Closure Devices ◽

Increasing Risk

With the vast increase in endovascular procedures and the use of percutaneous vascular closure devices, there is an increasing risk of closure failure and bleeding demanding open surgical repair that might be surgically challenging. We describe two ways, using a modern hybrid technique and tools (endovascular and open surgery), of controlling bleeding with minimal blood loss, which might facilitate the surgery.

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Use of vascular closure devices for endovascular interventions requiring a direct puncture of PETE grafts

VASA ◽

10.1024/0301-1526/a000677 ◽

2018 ◽

Vol 47 (2) ◽

pp. 119-124 ◽

Cited By ~ 2

Author(s):

Artur I. Milnerowicz ◽

Aleksandra A. Milnerowicz ◽

Marcin Protasiewicz ◽

Wiktor Kuliczkowski

Keyword(s):

Statistical Significance ◽

Vascular Complications ◽

Vascular Complication ◽

Inguinal Region ◽

Closure Device ◽

Manual Compression ◽

Direct Puncture ◽

Endovascular Interventions ◽

Vascular Closure Devices ◽

Closure Group

Abstract. Background: Effectiveness of vascular closure devices during endovascular procedures requiring a direct puncture of a vascular prosthesis placed in the inguinal region is unknown. Patients and methods: The retrospective analysis included 134 patients with a history of polyethylene terephthalate (PETE) graft implantation in the inguinal region. In 20 (15 %) patients, haemostasis was achieved with manual compression, in 21 (16 %) with the StarClose™, and in 93 (69 %) with the AngioSeal™ device. Results: The incidence of vascular complications in the manual compression group was higher (at a threshold of statistical significance) than in the device closure group (45.0 vs. 24.5 %, p = 0.059). The difference was considered statistically significant when manual compression was compared with the AngioSeal™ closure group (45.0 vs. 13.9 %, p < 0.01). The vascular complication rate in the StarClose™ group was significantly higher than in the AngioSeal™ group (71.4 vs. 13.9 %, p < 0.000001). While haematomas were the only vascular complications observed after application of AngioSeal™, both haematomas and pseudoaneurysms were found in the StarClose™ group. Conclusions: The AngioSeal™ vascular closure device provides better local haemostasis than the StarClose™ device or manual compression during endovascular interventions requiring a direct puncture of PETE grafts

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