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

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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First use of the Manta closure-device in ruptured abdominal aortic aneurysm patients and its potential usage for urgent endovascular procedures: A short report

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v2i1.42 ◽

2018 ◽

Vol 2 (1) ◽

Author(s):

David McGreevy

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Procedures ◽

Closure Device ◽

Short Report ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic

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Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies: The Bio4amb Multicentre Trial

CardioVascular and Interventional Radiology ◽

10.1007/s00270-020-02738-5 ◽

2020 ◽

Author(s):

Marianne Brodmann ◽

◽

Koen Deloose ◽

Eric Steinmetz ◽

Olivier Regnard ◽

...

Keyword(s):

Closure Device ◽

Peripheral Vascular ◽

Primary Analysis ◽

Access Site ◽

Femoral Access ◽

Vascular Closure Devices ◽

Total Procedure Time ◽

American Society ◽

Device Use ◽

Ambulatory Procedures

Abstract Purpose Ambulatory peripheral vascular interventions have been steadily increasing. In ambulatory procedures, 4F devices might be particularly useful having the potential to reduce access-site complications; however, further evidence on their safety and efficacy is needed. Materials and Methods BIO4AMB is a prospective, non-randomized mulitcentre, non-inferiority trial conducted in 35 centres in Europe and Australia comparing the use of 4F- and 6F-compatible devices. The main exclusion criteria included an American Society of Anaesthesiologists class ≥ 4, coagulation disorders, or social isolation. The primary endpoint was access-site complications within 30 days. Results The 4F group enrolled 390 patients and the 6F group 404 patients. Baseline characteristics were similar between the groups. Vascular closure devices were used in 7.7% (4F group) and 87.6% (6F group) of patients. Patients with vascular closure device use in the 4F group were subsequently excluded from the primary analysis, resulting in 361 patients in the 4F group. Time to haemostasis was longer for the 4F group, but the total procedure time was shorter (13.2 ± 18.8 vs. 6.4 ± 8.9 min, p < 0.0001, and 39.1 ± 25.2 vs. 46.4 ± 27.6 min, p < 0.0001). Discharge on the day of the procedure was possible in 95.0% (4F group) and 94.6% (6F group) of patients. Access-site complications were similar between the groups (2.8% and 3.2%) and included predominantly groin haematomas and pseudoaneurysms. Major adverse events through 30 days occurred in 1.7% and 2.0%, respectively. Conclusions Ambulatory peripheral vascular interventions are feasible and safe. The use of 4F devices resulted in similar outcomes compared to that of 6F 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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Delayed Complication from a Percutaneous Vascular Closure Device following a Neuro-Interventional Procedure

Interventional Neuroradiology ◽

10.1177/159101991101700417 ◽

2011 ◽

Vol 17 (4) ◽

pp. 495-500 ◽

Cited By ~ 1

Author(s):

A. Khaldi ◽

B. Waldau ◽

C. Skowlund ◽

G.J. Velat ◽

J. Mocco ◽

...

Keyword(s):

Interventional Procedure ◽

Limb Ischemia ◽

Fistula Formation ◽

Closure Device ◽

Femoral Access ◽

Jude Medical ◽

Vascular Closure Devices ◽

Increased Risk ◽

Delayed Complication ◽

Initial Procedure

Percutaneous vascular closure devices are being increasingly used as alternatives to manual compression for the closure of femoral arteriotomy after endovascular procedures as they appear to reduce time to ambulate, improve patient's comfort, and are implicated with cost saving. However, vascular closure devices have been associated with an increased risk of complications including hematoma formation, local bleeding, arteriovenous fistula formation, pseudoaneurysm and arterial leg ischemia. To our knowledge, if the above complications occur it is usually within the first 30 days after the procedure. None have been reported in a delayed fashion ten months or longer after closure. We describe a 30-year-old man with a history of a giant basilar trunk aneurysm. He was placed on aspirin and clopidogrel prior to the procedure. He had bilateral femoral access with 6 French sheaths. Following the procedure, 6 French Angio-Seals (St. Jude Medical, St. Paul, MN, USA) were used for closure of bilateral femoral arteriotomies. Ten months after the procedure, the patient kicked a metal cart and developed a large right retroperitoneal iliopsoas hematoma. There was no evidence of pseudoaneurysm. The patient was managed conservatively and his serial hematocrit stayed stable. He did not require surgical intervention. Use of percutaneous vascular closure devices is associated with complications including risk of hematoma, pseudoaneurysm, intravenous fistula, rectal peritoneal hemorrhage, limb ischemia and possible surgical repair. Most complications occur peri-procedure or within 30 days postprocedure. This is the first reported case of a delayed complication at ten months after the initial procedure. Site-related complications associated with percutaneous vascular closure devices may occur in a delayed fashion, even ten months postprocedure, so should be considered in the management of patients.

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EXTERNAL MECHANICAL COMPRESSION AFTER IMPLANTATION OF VASCULAR CLOSURE DEVICES IN PATIENTS UNDERGOING CARDIAC CATHETERIZATION BY FEMORAL ACCESS: AN OVERKILL?

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2015.07.050 ◽

2015 ◽

Vol 31 (10) ◽

pp. S17

Author(s):

N. Pinilla-Echeverri ◽

I. Sanchez-Perez ◽

A. Jurado-Roman ◽

F. Lozano-Ruiz Poveda ◽

M.T. Lopez-Lluva ◽

...

Keyword(s):

Cardiac Catheterization ◽

Mechanical Compression ◽

Femoral Access ◽

Vascular Closure Devices

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Das rupturierte infrarenale Aortenaneurysma – eine kritische Analyse

VASA ◽

10.1024/0301-1526.28.1.30 ◽

1999 ◽

Vol 28 (1) ◽

pp. 30-33 ◽

Cited By ~ 9

Author(s):

Bürger ◽

Meyer ◽

Tautenhahn ◽

Halloul

Keyword(s):

Aortic Aneurysm ◽

Aortic Rupture ◽

Anesthetic Management ◽

Objective Evaluation ◽

Left Ventricular ◽

Apache Ii ◽

Apache Ii Score ◽

Infrarenal Aortic Aneurysm ◽

Emergency Situations ◽

Probability Of Death

Background: Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. Patients and methods: Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56–89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course was complicated significantly in 34 patients. The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of death of more than 40% in five patients and lower than 30% in 17 others. No patient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). Conclusions: Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient’s prognosis can be approximated using APACHE II score. Treatment results of heterogenous patient groups can be compared.

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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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Management and Prevention of Vascular Complications Related to Transcatheter Aortic Valve Implantation and Aortic Aneurysm Repair Procedures – A Technical Note

Interventional Cardiology Review ◽

10.15420/icr.2010.5.1.81 ◽

2010 ◽

Vol 5 (1) ◽

pp. 81

Author(s):

Andrea Pacchioni ◽

Dimitris Nikas ◽

Carlo Penzo ◽

Salvatore Saccà ◽

Luca Favero ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Aneurysm ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Vascular Complications ◽

Technical Note ◽

Closure Device ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) are increasingly being used as therapeutic options for patients with severe aortic stenosis who are ineligible for surgery and who have aortic aneurysm with suitable anatomical features. These procedures can be associated with severe complications, especially related to vascular access and the use of a large introducer sheath (from 18 to 24 French [Fr]). In this article we describe possible vascular complications emerging during TAVI and EVAR and their appropriate management, beginning with patient selection, the correct way to perform vessel puncture and the use of a vascular closure device, up to the recently proposed cross-over technique, which is thought to minimise the risk of dangerous consequences of vascular damage.

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