Stenosis Caused by Suture-Mediated Vascular Closure Device in an Angiographic Normal Common Femoral Artery: Its Mechanism and Management

Vascular closing devices (VCDs) are widely used to replace manual compression at the femoral puncture site and to reduce the discomfort of patients undergoing percutaneous coronary procedure by shortening bed rest. Among the vascular complications related to these devices, the femoral artery stenosis or occlusion is rarely reported, and its standard management is not well established. We report a case of symptomatic femoral artery stenosis caused by suture-mediated VCD and managed using rotational atherectomy device and balloon angioplasty. In addition, we propose the possible mechanisms for this complication.

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Treatment of Infected Pseudoaneurysm of Femoral Artery after Vascular Closure Device Deployment: A Practical Solution

Case Reports in Vascular Medicine ◽

10.1155/2012/292945 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Predrag Matic ◽

Srdjan Babic ◽

Slobodan Tanaskovic ◽

Dario Jocic ◽

Djordje Radak

Keyword(s):

Femoral Artery ◽

Arterial Occlusion ◽

Surgical Excision ◽

Common Femoral Artery ◽

Coronary Intervention ◽

Closure Device ◽

Arteriovenous Fistulas ◽

Percutaneous Coronary ◽

Infected Pseudoaneurysm ◽

Device Deployment

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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Vascular closure devices in TAVI: MANTA versus ProGlide in a propensity-matched population

European Heart Journal ◽

10.1093/ehjci/ehaa946.2588 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Sa Mendes ◽

A Oliveira ◽

R Campante Teles ◽

P Araujo Goncalves ◽

J Brito ◽

...

Keyword(s):

Propensity Score ◽

Learning Curve ◽

Primary Endpoint ◽

Femoral Artery ◽

Statistical Significance ◽

Vascular Complications ◽

Artery Stenosis ◽

Closure Device ◽

Efficacy And Safety ◽

Life Threatening

Abstract Background Vascular complications increase morbidity and mortality in transcatheter aortic valve implantation (TAVI). A collagen plug-based closure device - MANTA® was recently introduced as an alternative to the suture-mediated ProGlide® vascular closure device (VCD). Data regarding the efficacy and safety comparing both VCD is scarce. The present study sought to compare the effectiveness of both devices. Methods Single center retrospective analysis on prospectively collected data of 300 consecutive patients who underwent TAVI using MANTA® or ProGlide® since 2018. A 1:1 propensity-score matched population derived by a multivariate logistic regression model based on age, sex, body mass index, pre-procedural haemoglobin, EuroSCORE II, main access calcification and the sheath-to-artery ratio. The primary endpoint was the composite of major or life-threatening bleeding (VARC-2 definition), femoral artery stenosis/dissection, pseudoaneurysm and need for endovascular/surgical bailout intervention. Results The propensity score matching resulted in 129 matched pairs. The median age was 84 years old [IQR 80–87], 42% males with a median EuroSCOREII of 4.29% [IQR 3.05–6.24]. There were no differences in the primary endpoint between MANTA ® and ProGlide® cohorts (3.9% vs 7.8%, p=0.287, respectively). The rates of the primary endpoint with the MANTA® device decreased with center experience, with relatively steep learning curve effect concerning device success. Major or life-threatening bleeding (3.1% vs 5.4%, p=0.540) and pseudoaneurysm (0.8% vs 2.3%, p=0.622) occurred less frequently in MANTA® cohort, but the differences did not reach statistical significance. Endovascular (stent or balloon) or surgical rescue intervention (9.3% vs 5.4%, p=0.341) and femoral artery stenosis/dissection (6.2% vs 3.1%, p=0.376), were also similar rates. In ProGlide® cohort, to achieve VCD success (without primary endpoint events), 15.5% needed more than 2 devices, significantly different from MANTA ® (p<0,001). Conclusions In patients undergoing transfemoral TAVI, the MANTA® VCD showed a similar efficacy and safety compared to the ProGlide® device and it reduced significantly the need of additional VCDs for completion of hemostasis. These results were obtained despite a clear learning curve associated with MANTA. Funding Acknowledgement Type of funding source: None

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Accelerated ambulation after vascular access closure device

Therapeutic Advances in Cardiovascular Disease ◽

10.1177/1753944718756604 ◽

2018 ◽

Vol 12 (5) ◽

pp. 141-144 ◽

Cited By ~ 2

Author(s):

Daniel Brancheau ◽

Sinan Sarsam ◽

Mahmoud Assaad ◽

Marcel Zughaib

Keyword(s):

Medical Device ◽

Femoral Artery ◽

Bed Rest ◽

Common Femoral Artery ◽

Closure Device ◽

Early Ambulation ◽

Jude Medical ◽

Diagnostic Cardiac Catheterization ◽

The Common ◽

To Receive

Background: Patients who are candidates to receive an Angioseal® (St. Jude Medical) device for arteriotomy closure are allowed to ambulate 20 min after the deployment of the device. More frequently, however, patients are kept on bed rest for several hours following Angioseal® deployment. The purpose of this study was to prospectively assess patients when ambulating 20 min after Angioseal® deployment instead of prolonged best rest of 2–3 h. Methods: Patients undergoing angiography from the common femoral artery approach were included in the study if they received a 6 Fr Angioseal® closure device. Results: Twenty-nine patients were successfully enrolled in the study; 27 (93.1%) patients ambulated at 20 min, 1 (3.45%) patient ambulated at 28 min, and 1 (3.45%) patient ambulated at 27 min due to transport times. There were zero complications with regard to hemorrhage or other groin complications. There is a substantial time difference in ambulation times between the conventional and early ambulation groups. Conclusion: Our study demonstrates that it is probably safe to ambulate patients who undergo diagnostic cardiac catheterization as early as 20 min after deployment of the 6 Fr Angioseal® closure device. ClinicalTrials.gov identifier: NCT03142126

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Intravascular Images of Common Femoral Artery Stenosis as a Complication of the Repeated Use of a Suture-mediated Closure Device

Angioscopy ◽

10.15791/angioscopy.cr.19.0026 ◽

2019 ◽

Vol 5 (1) ◽

pp. 14-18

Author(s):

Masato Matsushita ◽

Masamichi Takano ◽

Yasushi Miyauchi ◽

Wataru Shimizu

Keyword(s):

Femoral Artery ◽

Common Femoral Artery ◽

Artery Stenosis ◽

Closure Device ◽

Repeated Use

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Common femoral artery stenosis after deployment of vascular clip closure device

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.21435 ◽

2008 ◽

Vol 71 (6) ◽

pp. 736-737 ◽

Cited By ~ 5

Author(s):

Larry A. Osborn ◽

Harold Sunderman ◽

Mark Langsfeld

Keyword(s):

Femoral Artery ◽

Common Femoral Artery ◽

Artery Stenosis ◽

Closure Device ◽

Clip Closure

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Closure device use for common femoral artery antegrade access is higher risk than retrograde access

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.03.009 ◽

2021 ◽

Author(s):

Joel L. Ramirez ◽

Eric J.T. Smith ◽

Devin S. Zarkowsky ◽

Jose Lopez ◽

Caitlin W. Hicks ◽

...

Keyword(s):

Femoral Artery ◽

Common Femoral Artery ◽

Closure Device ◽

Device Use

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A New Access Site Management Tool: The Angio-Seal™ Hemostatic Puncture Closure Device

Journal of Endovascular Therapy ◽

10.1177/152660289500200309 ◽

1995 ◽

Vol 2 (3) ◽

pp. 289-296 ◽

Cited By ~ 4

Author(s):

Michel Henry ◽

Max Amor ◽

Mohamed Allaoui ◽

Olivier Tricoche

Keyword(s):

Arterial Wall ◽

Bypass Graft ◽

Vascular Complications ◽

Common Femoral Artery ◽

Management Tool ◽

Closure Device ◽

Manual Compression ◽

Vascular Closure Device ◽

Arterial Lumen ◽

Manual Pressure

Purpose: Given the increasing number of percutaneously applied endovascular therapies, the incidence of access-related vascular complications can be expected to rise, particularly in association with those techniques requiring large sheaths or anticoagulation. The need exists for a safe, easy to use, and effective hemostatic technique to replace the labor-intensive method of manual compression. Methods: A bioabsorbable, sheath-delivered vascular closure device (Angio-Seal™) has been developed that deposits a small collagen plug within the arterial wall to mechanically seal the puncture defect. An anchor connected by suture to the plug is first deployed in the arterial lumen and pulled flush against the interior arterial wall to guard against intraluminal deposition of the collagen. Results: The Angio-Seal device was deployed successfully in 80 (96%) of 83 attempts involving common femoral arteries accessed for peripheral angioplasty (n = 30), coronary angiography (n = 30), and coronary angioplasty (n = 16). Three popliteal artery access sites and one femoropopliteal bypass graft were also treated. Hemostasis was immediate in 78 cases (98%); 2 sites required a 5-minute manual compression to effect a secure seal. Three devices failed to deploy, and manual pressure was used to close the puncture. Nondeployment did not cause any sequelae, and no complications were encountered with the technique. Conclusions: This novel vascular closure device is quick (< 1 minute application time) and simple to use, providing a positive seal of common femoral artery puncture sites for both peripheral and coronary interventions. It appears to be a reliable alternative to standard manual hemostasis.

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Anomalous High Bifurcation of the Common Femoral Artery at the Groin: Management of Gsv Incompetence with Endovenous Laser Ablation

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2012.012047 ◽

2012 ◽

Vol 28 (5) ◽

pp. 264-267 ◽

Cited By ~ 1

Author(s):

C Lekich ◽

W Campbell ◽

S Walton ◽

P Hannah

Keyword(s):

Laser Ablation ◽

Femoral Artery ◽

Vascular Complications ◽

Common Femoral Artery ◽

Vascular Anomalies ◽

Endovenous Laser Ablation ◽

Safe Treatment ◽

Complications Of Surgery ◽

The Common ◽

Saphenofemoral Junction

Objectives: To discuss safety of EVLA in anomalies of the GSV anatomy. To review and discuss complications of surgery involving anomalous anatomy. Method: We report a case of high bifurcation of the common femoral artery wrapping around the saphenofemoral junction. Results: Successful ablation was achieved with no adverse consequences. Conclusion: EVLA is a safe treatment for SFJ/GSV incompetence in the presence of vascular anomalies that have historically resulted in serious vascular complications from surgery.

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