scholarly journals Femoral artery occlusion with a percutaneous arterial closure device after a routine coronary angiogram: a case report and literature review

2011 ◽  
Vol 93 (6) ◽  
pp. e102-e104 ◽  
Author(s):  
T Hussain ◽  
S Al-Hamali
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Vessel Diameter ◽  
Artery Occlusion ◽  
Arterial Puncture ◽  
Closure Device ◽  
Coronary Angiogram ◽  
Puncture Site ◽  
Vascular Closure Devices

Groin vessels are most commonly used to obtain vascular access for angiography because of their size and accessibility. Haemostasis at the puncture site can be achieved with manual compression alone or by using a vascular closure device. We highlight the case of a 68-year-old woman who developed acute claudication in the right leg after a routine diagnostic coronary angiogram when an Angio-Seal™ device had been employed to close a relatively low arterial puncture. On exploring the common femoral artery, fragments of the device were found occluding the bifurcation. A patch angioplasty was carried out and the patient’s claudicant symptoms improved. The Angio-Seal™ device has a polylactide and polyglycolide polymer anchor, a collagen plug and a suture contained within a carrier system. Haemostasis is achieved by compressing the arterial puncture site between the anchor and the collagen plug. The manufacturer’s recommended criterion for using the device safely permits its use only for common femoral artery punctures with an internal vessel diameter of 4mm. Anatomical confirmation of the puncture site and evidence of any arterial disease or stenosis in the artery is detected on fluoroscopy during the procedure. Recent meta-analyses have cast doubt on the assumption that vascular closure devices are superior to mechanical compression alone and serious complications do occur occasionally but are under-reported. Clinicians should be aware of the potentially serious problems that may occur when deciding to employ vascular closure devices, especially with an anatomically low puncture site.

scholarly journals Incidence of delayed angiographic femoral artery complications using the EXOSEAL vascular closure device

2015 ◽  
Vol 21 (3) ◽  
pp. 401-406 ◽  
Author(s):  
Ramesh Grandhi ◽  
Xiaoran Zhang ◽  
David Panczykowski ◽  
Phillip Choi ◽  
Christopher T Hunnicutt ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Vascular Complications ◽  
Arterial Puncture ◽  
Closure Device ◽  
Arterial Access ◽  
Vascular Closure Devices ◽  
Study Population ◽  
Clinically Significant ◽  
Angiographic Findings

Background and purpose Femoral artery injuries are known complications of percutaneous vascular closure devices (VCDs). We studied the incidence of delayed femoral artery angiographic irregularities after neurointerventional procedures in which the EXOSEAL extravascular closure device was used for femoral arterial puncture closure. Methods Adult patients who underwent femoral arterial puncture closures with an EXOSEAL VCD and had a follow-up femoral artery angiogram from June 2012 through August 2013 were reviewed. A blinded radiologist compared pre-deployment and follow-up femoral arteriograms for the presence of femoral artery stenosis, dissection, pseudoaneurysm, or development of an arteriovenous fistula. Hospital records were reviewed for major or minor complications of the groin site or femoral artery. Results The EXOSEAL VCD achieved hemostasis, without evidence of a groin hematoma or requiring subsequent prolonged manual compression, in 400 of 441 closures following transfemoral arterial access, representing a device success rate of 90.7%. A total of 98 patients underwent 102 repeat angiograms following closure with the EXOSEAL VCD. The average time to the repeat angiogram was 73.5 days (range 0–488, median 28). Follow-up femoral arteriography demonstrated an irregularity in seven cases, all of which were vessel stenoses of <50%. There were no dissections, pseudoaneurysms, infections, or ischemic events in the study population. Conclusions Angiographic irregularities were seen in 6.86% of cases after closure with the EXOSEAL VCD. There were no clinically significant vascular complications. Thus, femoral artery closure with EXOSEAL carries a low risk of clinically significant delayed angiographic findings.

FemoSeal® vascular closure device for antegrade common femoral artery access: Safety and technical notes

2019 ◽  
Vol 21 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Francesco Bruno Tagliaferro ◽  
Gianluigi Orgera ◽  
Luca Mascagni ◽  
Florindo Laurino ◽  
Marcello Andrea Tipaldi ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Platelet Count ◽  
Femoral Artery ◽  
Partial Thromboplastin Time ◽  
Common Femoral Artery ◽  
International Normalized Ratio ◽  
Closure Device ◽  
Technical Success ◽  
Vascular Closure Device ◽  
Puncture Site

Purpose: To retrospectively assess the efficacy and safety of FemoSeal® vascular closure device to achieve hemostasis following antegrade common femoral artery puncture after lower limb revascularization using vascular sheaths from 5 to 8 Fr. Methods: We reviewed the hemostatic outcome achieved with FemoSeal in 103 consecutive patients (mean age: 69 ± 8 years, 71 males) that undergone to 111 antegrade common femoral artery accesses for percutaneous lower limbs revascularization using 5- to 8-Fr vascular sheaths. We used FemoSeal in an unselected population, without exclusion criteria. The primary outcome was the technical success, meant as achieving complete hemostasis without immediate complications. Results: Hemostasis was achieved in all 111 puncture sites (100% technical success). We observed eight (7%) puncture site minor complications (hematomas), none of which affecting the patients’ outcome or requiring further therapies or increasing the hospital stay. There were no statistically significant differences between the variables potentially related to the occurrence of complications (age, international normalized ratio, platelet count, partial thromboplastin time ratio, body mass index, and common femoral arteries calcification grade) in patients with and without complications. Complications group mean body mass index was 26.4 ± 2.8 kg/m2 versus non-complications group 26.6 ± 4.4 kg/m2, p = 0.92. Mean international normalized ratio and partial thromboplastin time ratio were 1.05 ± 0.01 and 1.05 ± 0.14 versus 1.13 ± 0.2 (p = 0.39) and 1.12 ± 0.23 (p = 0.53), respectively. Common femoral arteries calcification grade was the same (mean: 1, p = 1). Platelet count was 202 × 103/mL ± 66.7 versus 226 × 103/mL ± 91.2, p = 0.55. Mean age was 72.3 ± 10 years versus 72.8 ± 8 years, p = 0.86. Conclusion: The low rate (7%) and grading of the adverse events, combined with the high technical success rate (100%), in an unselected group of patients treated in daily routine, suggest high safety and efficacy of FemoSeal vascular closure device in antegrade common femoral artery puncture site hemostasis when using vascular sheaths ranging from 5 to 8 Fr. Therefore, FemoSeal could be considered as a first-line hemostasis strategy in such cases.

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

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

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

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.

Heterogeneous limb vascular responsiveness to shear stimuli during dynamic exercise in humans

2005 ◽  
Vol 99 (1) ◽  
pp. 81-86 ◽  
Author(s):  
D. Walter Wray ◽  
Abhimanyu Uberoi ◽  
Lesley Lawrenson ◽  
Russell S. Richardson
Keyword(s):  
Shear Rate ◽  
Femoral Artery ◽  
Vascular Reactivity ◽  
Knee Extensor ◽  
Common Femoral Artery ◽  
Vessel Diameter ◽  
Substantial Improvement ◽  
Dynamic Exercise ◽  
Vascular Responsiveness ◽  
Conduit Vessel

Arm and leg vascular responsiveness to comparable shear stimuli during isolated dynamic exercise has not been assessed in humans. Consequently, six young cyclists performed incremental, intermittent handgrip exercise (arm) and knee-extensor exercise (leg) from 5 to 60% of maximal work rate (WR). Ultrasound Doppler measurements were taken in the brachial artery (BA), common femoral artery (CFA), and deep femoral artery (DFA) at rest and at each WR to assess diameter and sheer rate changes. Exercise at 60% maximum WR increased shear rate to the same degree in the CFA (314.3 ± 33.3 s−1) and BA (303.3 ± 26.3 s−1), but was significantly higher in the DFA (712.6 ± 88.3 s−1). Compared with rest, exercise at 60% maximum WR did not alter CFA vessel diameter, but increased BA diameter (0.42 ± 0.01 to 0.49 ± 0.01 cm) and DFA diameter (0.59 ± 0.05 to 0.64 ± 0.04 cm). These data from the DFA demonstrate for the first time a substantial improvement in vascular reactivity in a conduit vessel only slightly distal to the CFA. However, despite comparable dilation between the BA and DFA, the slope of the relationship between vessel diameter and shear rate was much greater in the arm (2.4 × 10−4 ± 4.6 × 10−5 cm/s) than in either the DFA (8.9 × 10−5 ± 1.5 × 10−5 cm/s) or CFA (2.1 × 10−5 ± 1.1 × 10−5 cm/s). Together, these findings reveal a substantial heterogeneity in vascular responsiveness in the leg during dynamic exercise but demonstrate that conduit vessel dilation for a given change in shear rate is, nonetheless, reduced in the leg compared with the arm.

Surgical treatment of arterial ischemia associated with the use of the angioseal vascular closure device

VASA ◽  
2009 ◽  
Vol 38 (4) ◽  
pp. 334-337 ◽  
Author(s):  
Pontón ◽  
Negueruela ◽  
Bernal ◽  
García ◽  
Arnáiz ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Surgical Techniques ◽  
Common Femoral Artery ◽  
Point Of View ◽  
Heart Catheterization ◽  
Closure Device ◽  
Arterial Lesions ◽  
Arterial Repair ◽  
Atheroma Plaque

Background: Despite the theoretical effectiveness of the Angio-Seal closure device to control bleeding after arterial puncture it can increase the risk of ischemia. Objectives: To describe arterial lesions caused by the device, surgical techniques needed to repair those lesions and surgical outcome in patients who underwent surgery for arterial ischemia after heart catheterization. Patients and methods: Seven patients underwent surgery over a period of 12 months at our institution. Five patients underwent emergency surgery and two a delayed procedure. The cause of ischemia was dissection of an atheroma plaque at the puncture site in four cases, dissection of the superficial femoral artery in one case, thrombosis of the common femoral artery in one case, and plication of the posterior arterial wall in one case. Arterial repair in these patients required the insertion of a vascular graft in three cases, endarterectomy plus angioplasty in two cases, endarterectomy plus graft interposition plus thrombectomy of the superficial femoral artery in one case and endarterectomy plus femoropopliteal bypass in one case. Results: Treatment was successful in all patients. Mean follow up was 7.6 months (range 5-11 months). During the study period one patient died due to cardiopathy. No patients had to be re-operated and no limb losses were recorded. All the patients were asymptomatic from a vascular point of view with normal active lives for their age. Conclusions: Surgical repair is effective, although, generally, it is not restricted to a simple thrombectomy, requiring the use of different arterial repair techniques

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