Hemostasis After Brachial Artery Access With the MynxGrip Device: A Case Report

Purpose: Brachial access is occasionally used for endovascular procedures when other more established or safer ones (eg, femoral or radial) are contraindicated. Although manual compression is the standard of care after brachial arteriotomy, suboptimal compression may lead to bleeding or thrombosis. Arteriotomy closure devices have thus been proposed as an alternative means to achieve hemostasis after brachial arteriotomy. Yet, there is a paucity of evidence and a limited spectrum of devices suitable for brachial arteriotomy closure. We present the use of the MynxGrip closure device after brachial arteriotomy. Case: A 70-year-old gentleman underwent brachial arteriotomy followed by iliac artery stenting with a 7F compatible device. Hemostasis was then achieved with the MynxGrip device, uneventfully. Conclusions: This clinical vignette highlights the feasibility and safety of brachial use of the MynxGrip device in experienced hands, suggesting that it can represent a useful adjunct to the armamentarium of the endovascular specialist.

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A Stopped Pilot Study of the ProGlide Closure Device After Transbrachial Endovascular Interventions

Journal of Endovascular Therapy ◽

10.1177/1526602819862775 ◽

2019 ◽

Vol 26 (5) ◽

pp. 727-731 ◽

Cited By ~ 2

Author(s):

Max M. Meertens ◽

Michiel W. de Haan ◽

Geert W. H. Schurink ◽

Barend M. E. Mees

Keyword(s):

Pilot Study ◽

Brachial Artery ◽

Secondary Outcome ◽

Control Group ◽

Closure Device ◽

Manual Compression ◽

Access Site ◽

Historical Cohort ◽

Endovascular Interventions ◽

High Incidence

Purpose: To evaluate the feasibility and safety of the suture-mediated ProGlide device in closure of the brachial artery after endovascular interventions. Materials and Methods: From 2016 to 2017, a pilot study was performed using the ProGlide to achieve hemostasis after percutaneous access of distal brachial arteries >4 mm in diameter. In an interim analysis, the results were compared to a matched control group taken from a 60-patient historical cohort who underwent brachial artery access and manual compression to achieve hemostasis between 2014 and 2017. The primary outcome was access-related reintervention and the secondary outcome was the incidence of access-site complications. Results: Seven patients (mean age 67.9 years; 6 men) were enrolled in the study before it was stopped in 2017. Four patients experienced 6 access-site complications (neuropathy, hematoma, occlusion, and pseudoaneurysm). These resulted in 3 access-related reinterventions: surgical evacuation of a hematoma, thrombectomy of the occluded brachial artery, and surgical repair of the pseudoaneurysm. In the interim comparison to the 19 matched patients (mean age 61.9 years; 6 men), the ProGlide group had proportionally more patients experiencing access-related complications (57% vs 16% for manual compression, p=0.035) and resultant reinterventions (43% vs 11%, p=0.064). Based on this data the trial was stopped. Conclusion: Considering this experience, it is not advisable to use the ProGlide in transbrachial endovascular interventions due to the high incidence of complications and access-related reinterventions.

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An attempt to retrieve an embolized ductal closure device leading to iliac artery dissection in an 11-month-old child: A case report

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2019.16753 ◽

2019 ◽

Vol 27 (1) ◽

pp. 111-113 ◽

Cited By ~ 1

Author(s):

Emrah Şişli

Keyword(s):

Case Report ◽

Iliac Artery ◽

Artery Dissection ◽

Closure Device ◽

Ductal Closure

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Success and reliability of extrafemoral Exoseal vascular closure device: “Off-label” usage

Interventional Medicine and Applied Science ◽

10.1556/1646.11.2019.22 ◽

2020 ◽

Vol 11 (3) ◽

pp. 182-186

Author(s):

Ismail Caymaz ◽

Fuad Nurili ◽

Ozlem Kolcak ◽

Omer Aras ◽

Burcak Gumus

Keyword(s):

Brachial Artery ◽

Large Scale ◽

Endovascular Procedures ◽

Covered Stent ◽

Closure Device ◽

Minor Complication ◽

Technical Success ◽

Vascular Closure Device ◽

Artery Pseudoaneurysm ◽

Procedural Success

Aim The aim of this study is to present the reliability and efficacy of Exoseal vascular closure device (EVCD) for closure of extrafemoral punctures. Materials and methods All patients who were treated with EVCD following arterial endovascular treatment involving an extrafemoral puncture between April 2013 and January 2014 were examined retrospectively. This study included 11 patients (4 women and 7 men between the ages of 48 and 87 years; average age = 65 years). A total of 13 procedures were performed in 11 patients involving the following access routes: brachial artery (n = 5), popliteal artery (n = 4), and polytetrafluoroethylene graft (n = 4). Results Twelve out of 13 EVCD procedures achieved technical success and procedural success. One minor and one major complications occurred. Both complications were revealed to be pseudoaneurysms, both in the brachial artery. Pseudoaneurysm of the minor complication was treated by Fibrin Sealant (Tisseel) injection guided by ultrasonography and the other pseudoaneurysm was treated by covered stent placement. Conclusions The femoral artery is an essential access route of arterial endovascular procedures; however, in some cases, the extrafemoral arterial route is necessary. In this study, EVCD was found to be useful for closing extrafemoral arterial routes. This study had a limited number of cases and more large-scale studies are needed.

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Angioseal™ as a hemostatic device for direct carotid puncture during endovascular procedures

Interventional Neuroradiology ◽

10.1177/1591019915581991 ◽

2015 ◽

Vol 21 (2) ◽

pp. 273-276 ◽

Cited By ~ 13

Author(s):

Hugo Cuellar ◽

Leopoldo Guimaraens ◽

Sudheer Ambekar ◽

Elio Vivas ◽

Jacques Theron

Keyword(s):

Carotid Artery ◽

Endovascular Procedures ◽

Vascular Wall ◽

Closure Device ◽

Manual Compression ◽

Peripheral Vascular ◽

Hemodynamic Changes ◽

Off Label ◽

Post Procedure

Introduction Direct carotid artery puncture (DCP) is employed in patients with tortuous anatomy and peripheral vascular disease when the peripheral arteries are not available for vascular access. Manual compression is the only method of achieving hemostasis following DCP and, till date, the use of a closure device for DCP has been reported in only one patient. In this study we sought to analyze our experience with the use of closure device for DCP. Methods This is a retrospective study of patients in whom Angioseal™ was used following DCP for neuroendovascular procedures. Medical charts and imaging of these patients was reviewed for any abnormalities pertaining to the use of the closure device. Results A total of eight patients were included in the study. Angioseal™ was used in all the patients. There were no complications related to the use of the closure device in any of the eight patients. Immediate post-procedure angiography done in one patient did not show any structural or hemodynamic abnormalities within the carotid artery lumen. At 6 months follow-up imaging, there was no evidence stenosis or vascular wall abnormality in any of the patients. There were no adverse clinical reactions related to the use of closure device. Conclusion In our experience, Angioseal™ may be a safe and off-label effective closure device for patients undergoing DCP for neuroendovascular procedures. It obviates the need for manual compression without causing any structural or hemodynamic changes within the carotid artery. Larger studies with longer follow-up are required to establish its safety in patients undergoing DCP.

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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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Adventitial Cystic Disease of the External Iliac Artery - A Case Report

Swiss Surgery ◽

10.1024/1023-9332.7.2.90 ◽

2001 ◽

Vol 7 (2) ◽

pp. 90-94 ◽

Cited By ~ 4

Author(s):

Heim ◽

Rosso

Keyword(s):

Case Report ◽

Iliac Artery ◽

External Iliac Artery ◽

Cystic Disease ◽

Adventitial Cystic Disease ◽

Präoperative Abklärung

Die zystische Degeneration der Adventitia (ZAD) in der A.iliaca externa ist mit zehn in der Literatur beschriebenen Fällen ein seltenes Phänomen. Eine rasch auftretende, einseitige Ischämiesymptomatik bei jungen Patienten sollte daran denken lassen und eine erweiterte präoperative Abklärung zur Folge haben. Die klassische Therapie mit Gefässresektion und Veneninterponat wird seit jeher kontrovers diskutiert. Wir berichten über einen Fall mit rezidivfreiem Verlauf über drei Jahre nach Exarterektomie.

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Bilateral iliac artery pseudoaneurysm as a complication of lumbar spine surgery, case report

European Journal of Radiology ◽

10.1016/s0720-048x(02)00233-4 ◽

2002 ◽

Author(s):

H Ghanaati

Keyword(s):

Case Report ◽

Lumbar Spine ◽

Spine Surgery ◽

Iliac Artery ◽

Lumbar Spine Surgery ◽

Artery Pseudoaneurysm ◽

Iliac Artery Pseudoaneurysm

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Case Report: Hemoptysis localization – hearing with your eyes

POCUS Journal ◽

10.24908/pocus.v1i2.13253 ◽

2016 ◽

Vol 1 (2) ◽

pp. 7

Author(s):

Barry Chan, MD

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Hemodynamic Instability ◽

Clinical Vignette ◽

Massive Hemoptysis ◽

Airway Patency ◽

Peripheral Site ◽

Adventitious Sound

Clinical Vignette: 45 year old was transferred from a peripheral facility for acute massive hemoptysis though maintained sufficient airway patency with no evidence of hemodynamic instability or respiratory failure. Thoracic auscultation revealed vesicular breathing with no adventitious sound. CXR from the peripheral site was normal.

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