scholarly journals A Novel Intervention to Treat Failed Angio-Seal Footplate Deployment: Two Case Series

2019 ◽  
Vol 12 ◽  
pp. 117954761982871 ◽  
Author(s):  
Thomas C Hall ◽  
Said Habib
Keyword(s):  
Femoral Artery ◽  
Case Series ◽  
Arterial Occlusion ◽  
Artery Occlusion ◽  
Critical Limb Ischaemia ◽  
Closure Device ◽  
General Anaesthetic ◽  
Limb Ischaemia ◽  
Retrograde Approach ◽  
Femoral Artery Occlusion

Introduction: Vascular closure devices are commonly used to achieve rapid haemostasis and early ambulation following arterial puncture for endovascular procedures. Although device failure rates are low, the consequences of arterial occlusion include severe limb ischaemia. We describe a novel endovascular technique for the treatment of Angio-Seal arterial closure device (Terumo, Europe NV) failure causing femoral artery occlusion. Materials and methods: We describe 2 cases of lower limb angioplasty performed for critical limb ischaemia where the access site was closed using an Angio-Seal according to the manufacturer instructions for use (IFU). In both cases, however, ultrasound could not be used during deployment of the Angio-Seal due to body habitus and small subcutaneous haematoma. In both cases, the device failed and occluded the femoral artery. Results: Access was achieved via a retrograde approach from the contralateral limb in one case and a retrograde approach from the ipsilateral profunda artery in the other case. Angiography confirmed that the footplate of the Angio-Seal had occluded the femoral artery. Subsequently, the occlusion was crossed and a short balloon-mounted bare metal stent placed to push the footplate against the arterial wall that resulted in resolution of the occlusion and haemorrhage control. Conclusions: Crossing the occlusion caused by failure of the Angio-Seal closure device and subsequent stenting resulted in satisfactory relief of the femoral artery occlusion and haemostasis without the added risks of open surgical revascularisation and general anaesthetic.

Clinical outcomes from profundoplasty performed as a sole procedure for revascularization in critically ischaemic limbs

Vascular ◽  
2020 ◽  
pp. 170853812096390
Author(s):  
Mohamed Elsharkawi ◽  
Mohammed Elkassaby ◽  
Niall McVeigh ◽  
Joseph Dowdall ◽  
Mary Barry ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Artery Occlusion ◽  
Tissue Loss ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Rest Pain ◽  
Pain Group ◽  
Femoral Artery Occlusion ◽  
Artery Disease

Objectives The aim of this study is to investigate the durability and clinical efficacy of profundoplasty as a sole procedure in patients presenting with critical limb ischaemia associated with profunda femoral artery disease and superficial femoral artery occlusion. Methods Retrospective analysis of outcomes from all patients who underwent surgical profundoplasty in a single tertiary referral centre was performed. Patients who presented with either rest pain or tissue loss and had combined profunda femoral artery disease and superficial femoral artery occlusion were included in the study. Outcomes were compared between the rest pain and the tissue loss groups. Results Between 2009 and 2019, 51 procedures were performed in 49 patients; 27 (53%) procedures were performed for rest pain and 24 (47%) for tissue loss. Technical success was 100% in both groups. Procedure success was significantly better in the rest pain group owing to lower procedure-related complications ( p = 0.037). Incidence of major adverse cardiovascular events was higher in the tissue loss group with five reported cases compared to only one in the rest pain group ( p = .05); 85.2% of patients with rest pain experienced clinical improvement compared to only 33.3% in the tissue loss group ( p < .001). Higher rates of re-intervention were recorded in the tissue loss group, but this was not statistically significant. Amputation-free survival at 3, 6 and 12 months was 96%, 96% and 92% in the rest pain group, respectively, compared to 77%, 67% and 54% in the tissue loss group ( p = .004). At one-year, freedom from major adverse limb events was lower in patients with tissue loss at 43% compared to 81% in patients with rest pain ( p = .009). Conclusions Profundoplasty performed as a sole procedure for revascularisation of the critically ischaemic limb is a viable straightforward option. However, our results suggest that it may be more effective in the treatment of rest pain rather than in the setting of tissue loss when a combined superficial femoral artery angioplasty or distal bypass may be required.

Acute compensation to abrupt occlusion of rat femoral artery is prevented by NO synthase inhibitors

1994 ◽  
Vol 267 (6) ◽  
pp. H2523-H2530 ◽  
Author(s):  
J. L. Unthank ◽  
J. C. Nixon ◽  
M. C. Dalsing
Keyword(s):  
Femoral Artery ◽  
Arterial Occlusion ◽  
Artery Occlusion ◽  
No Synthase ◽  
Artery Blood Flow ◽  
Relaxing Factor ◽  
Femoral Artery Occlusion ◽  
Before And After ◽  
Endothelium Derived Relaxing Factor ◽  
Oxide Synthase

The hemodynamic significance of endothelium-derived relaxing factor (EDRF)-mediated mechanisms in vascular responses to abrupt rat femoral artery occlusion was investigated. Temporary arterial occlusion was produced before and after inhibition of nitric oxide synthase by N omega-nitro-L-arginine methyl ester (L-NAME) or NG-monomethyl-L-arginine (L-NMMA). Iliac artery blood flow and arterial pressures proximal and distal to the occlusion were measured. Normal vascular compensation included a return of resistance to preocclusion levels and a rise in distal pressure to a plateau within 5 min postocclusion. After treatment with L-NAME and L-NMMA, postocclusion resistance remained elevated by 53 and 36%, respectively. Collateral dilation after occlusion, as indicated by the rise in distal pressure, was prevented by L-NAME but not L-NMMA. Increases in adrenergic tone and mean arterial pressure by phenylephrine did not prevent compensation, suggesting the effects of L-NAME and L-NMMA did not result from elevated sympathetic activation or pressure. The results are consistent with the hypothesis that the stimulated release of endothelium-derived relaxing factor mediates the acute vascular compensation to abrupt arterial occlusion.

Cases of Femoral Artery Occlusion after using the Exoseal Closure Device: Including Experiment in Vascular Model

2015 ◽  
Vol 7 (3) ◽  
pp. 81-85
Author(s):  
Yosuke Takasawa ◽  
Sumio Mizuno ◽  
Junya Yamaguchi ◽  
Masatomo Suzuki ◽  
Masayuki Tsuchida ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Artery Occlusion ◽  
Closure Device ◽  
Vascular Model ◽  
Femoral Artery Occlusion

scholarly journals Angioscopic Observation of Acute Femoral Artery Occlusion Complicated by Use of Angio-seal Vascular Closure Device

Angioscopy ◽  
2015 ◽  
Vol 1 (1) ◽  
pp. 35-37
Author(s):  
Ryo Munakata ◽  
Masamichi Takano ◽  
Tomohito Hada ◽  
Tetsuro Shimura ◽  
Osamu Kurihara ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Artery Occlusion ◽  
Closure Device ◽  
Vascular Closure Device ◽  
Femoral Artery Occlusion

scholarly journals Prior exercise training produces NO-dependent increases in collateral blood flow after acute arterial occlusion

2002 ◽  
Vol 282 (1) ◽  
pp. H301-H310 ◽  
Author(s):  
H. T. Yang ◽  
Jie Ren ◽  
M. Harold Laughlin ◽  
Ronald L. Terjung
Keyword(s):  
Femoral Artery ◽  
Arterial Occlusion ◽  
Artery Occlusion ◽  
Treadmill Running ◽  
Collateral Blood Flow ◽  
Prior Training ◽  
Vascular Conductance ◽  
Running Speed ◽  
Femoral Artery Occlusion ◽  
Calf Muscles

We previously reported that prior training improves collateral blood flow (BF) to the calf muscles after acute-onset occlusion of the femoral artery (Yang HT et al. Am J Physiol Heart Circ Physiol 279: H1890–H1897, 2000). The purpose of this study was to test the hypothesis that increased release of nitric oxide (NO) by NO synthase (likely endothelial NOS) contributes to the increased BF to calf muscles of trained rats after acute femoral artery occlusion. Adult male Sprague-Dawley rats (∼325 g) were limited to cage activity and were sedentary (SED; n = 28) or exercise trained (TR; n = 30) for 6 wk by treadmill running. On the day of the investigation, rats were anesthetized with ketamine-acepromazine and instrumented for determination of BF (using 141Ce- and 85Sr-labeled microspheres) and distal limb arterial pressure, and femoral arteries were occluded bilaterally. Four hours after surgery, collateral BF was determined twice during treadmill running: first at a demanding speed (20 m/min, 15% grade) and second, after a brief rest and at a faster running speed (25 m/min, 15% grade). The fact that BF did not increase further at the higher running speed indicated that maximal collateral BF was measured. Approximately half of the rats in each group received 20 mg/kg body wt N G-nitro-l-arginine methyl ester (l-NAME) intra-arterially 30 min before treadmill exercise and BF measurement to block production of NO by NOS. Results indicate that prior training improved collateral-dependent BF to the skeletal muscle of rats after acute femoral artery occlusion due primarily to an increase in the conductance of the upstream collateral circuit. Blockade of NOS with l-NAME produced decreased vascular conductance, both in the upstream collateral circuit and in the distal skeletal muscle microcirculation, and the difference between collateral vascular conductance in TR and SED rats was abolished. Our results indicate that the primary determinant of the increased collateral BF with prior training is the resistance of the upstream collateral circuit and imply that enhanced endothelium-mediated dilation induced by training serves to increase collateral BF following acute arterial occlusion.

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