Histologic and Duplex Comparison of the Perclose and Angio-Seal Percutaneous Closure Devices

Vascular ◽  
2007 ◽  
Vol 15 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Nicholas J. Gargiulo ◽  
Frank J. Veith ◽  
Takao Ohki ◽  
Lawrence A. Scher ◽  
George L. Berdejo ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Vessel Diameter ◽  
Canine Model ◽  
Duplex Sonography ◽  
Percutaneous Closure ◽  
Artery Dissection ◽  
Closure Device ◽  
Jude Medical ◽  
Femoral Arteries ◽  
Time Required

The intravascular and extravascular effects of percutaneous closure devices have not been well studied. We assessed the performance and healing characteristics in dogs of two devices approved by the US Food and Drug Administration. Nine adult male dogs were anesthesized prior to percutaneous access of both femoral arteries with a 6F sheath. All dogs were systemically heparinized to an activated clotting time (ACT) > 250 seconds. Duplex sonography was performed preoperatively to measure vessel diameter and flow velocity. In each dog, one of two devices (Perclose, Abbot Laboratories, Abbott Park, IL or Angio-Seal, St. Jude Medical, St. Paul, MN) was randomly deployed into one of the two femoral arteries. The other device was deployed on the opposite side. Duplex sonography was repeated immediately after deployment and 28 days later to measure changes in vessel diameter and flow velocity. At 28 days, angiography was performed on both femoral arteries before they were removed for histologic evaluation. The time required to excise each vessel reflected the degree of scarring. Hemostasis time for the Angio-Seal device far surpassed the Perclose device (39 ± 7 vs 0 minutes; p < .05). Vessel narrowing was observed only at 28 days after deployment of the Angio-Seal device ( p < .05). Extensive extravascular scarring was observed with the Angio-Seal device, which resulted in a longer femoral artery dissection time and greater periadventitial scar thickness compared with the Perclose device ( p < .05). When compared with the Perclose suture closure device, the Angio-Seal collagen plug closure device prolonged hemostasis time and produced greater vessel narrowing and periadventitial inflammation (extravascular scarring) in a canine model at 4 weeks.

scholarly journals Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Arnaud Devriendt ◽  
Emmanuel Tran-Ngoc ◽  
Philippe Gottignies ◽  
José Castro-Rodriguez ◽  
Oliver Lomas ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Central Venous Access ◽  
High Risk Patient ◽  
Venous Access ◽  
Percutaneous Closure ◽  
Closure Device ◽  
Central Venous ◽  
Jude Medical ◽  
Vertebral Arteries ◽  
The Right

Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical). This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively.

Lokale Gefäßkomplikationen nach Einsatz des hämostatischen Verschlussystems Angio-SealTM

VASA ◽  
2002 ◽  
Vol 31 (2) ◽  
pp. 101-106 ◽  
Author(s):  
Kirchhof ◽  
Schickel ◽  
Schmidt-Lucke ◽  
Schmidt-Lucke
Keyword(s):  
Vascular Surgery ◽  
Cardiac Catheterization ◽  
Femoral Artery ◽  
Diagnostic Delay ◽  
Vascular Complications ◽  
Duplex Sonography ◽  
Closure Device ◽  
Device Application ◽  
Femoral Arteries ◽  
The Common

Background: As an alternative to manual pressure techniques new systems for achieving arterial hemostasis after cardiac catheterization were developed. Here we report about the diagnosis and therapy of femoral artery complications after use of the closure device Angio-SealTM, consisting of an intraarterial anchor and extravascular collagen plug. Patients and methods: Angio-SealTM was deployed in 350 patients undergoing cardiac catheterization. Vascular investigations after device application consisted of ankle/brachial-pressure-index measurement, duplex sonography, and angiography. Results: Vascular complications occurred in 10 of 350 patients. In two patients complete occlusions of the superficial femoral artery required immediate vascular surgery. Stenoses of the superficial (five patients) and the common (three patients) femoral arteries were diagnosed in 8 cases. Of these 10 patients eight were obese, in 2 cases there was a further catheterization with Angio-SealTM device application via the same femoral approach. Until now six patients underwent successful surgery: in 4 cases the whole Angio-SealTMdevice was located intraarterially, there was 1 case of intima-dissection, and 1 case remained unclear due to a diagnostic delay of 7 months. In three patients with stenoses of the common femoral arteries without hemodynamic relevance no therapy was required. Conclusions: Occlusions or stenoses of femoral arteries after use of Angio-SealTM can be diagnosed easily by duplex sonography. All hemodynamic relevant complications (n = 7 of 350 [2%]) concerned a puncture of superficial femoral arteries. In these patients vascular surgery seems to be an adequate therapy.

scholarly journals Percutaneous closure of iatrogenic anterior mitral leaflet perforation: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Hesham Abdo Naeim ◽  
Osama Amoudi ◽  
Abeer Mahmood ◽  
Reda Abuelatta
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Left Ventricular ◽  
Percutaneous Closure ◽  
The Body ◽  
Closure Device ◽  
Amplatzer Septal Occluder ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Septal Occluder Device

Abstract Background Severe mitral regurgitation (MR) through the body of the anterior mitral leaflet (AML) is rare. The cause either iatrogenic during open-heart surgery or due to infective endocarditis. We present a case where a successful percutaneous closure of the AML perforation was an alternative to surgery. Case summary A 60-year-old male presented with shortness of breath (SOB) class III of 12 months duration. He underwent coronary artery bypass surgery with four grafts plus mitral valve (MV) repair 20 months ago. Transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE) revealed severe MR through the body of AML at A3. The percutaneous closure plan was to cross the AML perforation from the left ventricular side. The venacontracta of the perforation was 6 mm, an amplatzer septal occluder device 6 mm considered appropriate for closure of this hole. A snare catheter snared the wire and exteriorized creating arteriovenous loop. Amplatzer septal occluder 6 mm loaded to the delivery system till larger disc (left-sided) opened safely and freely below the MV apparatus. Once the left ventricular side disc opposed the ventricular surface of AML, the waist and left atrial disc gently released. The patient discharged in the next day. After 6 months, the patient had no more SOB, he returned to his daily activity. Follow-up TTE showed no MR, the closure device was stable in place. Discussion We added a successful case of transcatheter AML perforation to the literature. The role of TOE is crucial in diagnosis and procedure guidance.

scholarly journals High-grade atrioventricular block occurring during percutaneous closure of patent foramen ovale: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Marion Kibler ◽  
Halim Marzak ◽  
Laurence Jesel ◽  
Patrick Ohlmann
Keyword(s):  
Atrioventricular Block ◽  
Patent Foramen Ovale ◽  
Atrioventricular Node ◽  
Percutaneous Closure ◽  
Right Atrial ◽  
Closure Device ◽  
High Grade ◽  
Foramen Ovale ◽  
Conduction Disturbances ◽  
Pfo Closure

Abstract Background  Percutaneous closure of patent foramen ovale (PFO) is recommended for patients presenting with PFO-related stroke. Acute high-grade conduction disturbances occurring during PFO closure procedure have not been previously reported. Case summary  We describe for the first time a case of reversible complete atrioventricular block which occurred during closure of a PFO. Discussion  We hypothesized that the block was the result of atrioventricular node compression—likely caused by the right-atrial disc of the 35-mm PFO closure device. We suggest implanting smaller devices in order to prevent atrioventricular conduction disturbances.

scholarly journals Sedation Effect of Acepromazine and Butorphanol in Dopplervelocimetric Parameters in Great Abdominal Arteries and Femoral Artery in Dogs

2018 ◽  
Vol 44 (1) ◽  
pp. 7
Author(s):  
Fabíola Peixoto da Silva Mello ◽  
Verônica Noriega Torres ◽  
Renata Ferreira Cunha ◽  
Tatiane Meirelles ◽  
Aline Silva Gouvêa ◽  
...  
Keyword(s):  
Heart Rate ◽  
Gastrointestinal Tract ◽  
Flow Velocity ◽  
Doppler Ultrasound ◽  
Abdominal Aorta ◽  
Femoral Artery ◽  
Doppler Spectrum ◽  
Femoral Arteries ◽  
Before And After ◽  
Time Average

Background: Doppler ultrasound is a non-invasive diagnostic imaging technique that allows vascular anatomical and dynamics evaluation. Each artery has flow velocity profiles and different Doppler spectrum. The purpose of this study was to determine if sedation with acepromazine and butorphanol in dogs alters Doppler velocimetric values and diameter from abdominal aorta, celiac, mesenteric cranial, renal, external iliac and femoral arteries of healthy dogs.Materials, Methods & Results: Twenty healthy female dogs, aged 1 to 5 years, with body weight ranging from 10 to 25 kg, were evaluated with Doppler ultrasound in order to obtain: peak systolic velocity, end diastolic velocity, time average medium velocity, time average maximum velocity, resistive index, pulsatility index, and diameter from abdominal aorta, celiac, mesenteric cranial, renal, external iliac and femoral arteries. The same animals were sedated with acepromazine (0.02 mg/kg) and buthorphanol (0.4 mg/kg) and the same parameters were reevaluated. The heart rate was also measured. The study was approved by the Animal Ethics Committee of UFRGS, under the 25552 protocol, and the owners signed an informed consent form. Statistical analysis was performed with pared t test.The heart rate was statistically significant different, 98 ± 20.13 bpm before and 79 ± 17.74 after sedation. The exam was done before and after sedation in all selected vessels, except the celiac and cranial mesenteric artery, which were possible only in 35% and 45% respectively. All measured arteries exhibit difference in at least two of the analyzed parameters, except femoral artery, that only diameter was different.Discussion: Each vessel was selected because of its importance, and each of them has its own characteristic waveform. Changes in patterns of flow velocity of the celiac artery and mesenteric can help to determine the physiological condition of the gastrointestinal tract; in the case of renal arteries are associated with diseases involving parenchyma and; thrombosis in the aorta and the iliac and femoral arteries may be difficult to evaluate without the Doppler image. Examination of the AC and AMC before and after sedation not could be performed in all animals, maybe because the present work was carried out with only fasting requirement, without using dimethicone, and one of the difficulties encountered was the presence of gas in the gastrointestinal tract. Another factor that may have contributed to these findings is that the acute stress of containment and other environmental factors can cause release of vasopressin and leads to vasoconstriction of the splanchnic vascular bed. The dopplervelocimetric data found in celiac, mesenteric cranial, renal and femoral arteries in non-sedated animals was similar to what was described by other authors. Although all dogs demonstrated relaxation during the exam, this sedation protocol alters the values found with Doppler ultrasound in the selected vessels, except femoral artery, which caused only increase of diameter. The Doppler differences found can be a consequence of a decrease in heart rate associated with longer cycle length, and therefore, larger diastolic volume with vessels that stayed with same diameter, or in case of caudal abdominal aorta, that reduced the diameter. This study compared the dopplervelocimetric values to the ones described by other authors in non-sedated animals and demonstrated that although acepromazine and buthorphanol are a good option to sedate dogs to perform ultrasound exam, they alter the Doppler values from aorta abdominal, celiac, cranial mesenteric, renal, external iliac arteries and the femoral artery diameter.

Sign in / Sign up

Export Citation Format

Share Document