Acute Claudication caused by Angio-Seal Closure Devices: a Report of Four Cases

Abstract

Femoral artery closure devices are increasingly used after percutaneous arterial interventions to obtain hemostasis at the puncture site. Their efficacy and advantages in patient comfort are established. Nevertheless they can cause their own specific complications. In a five month's period we had to treat four patients with sudden onset invalidating claudication after the use of an Angio-Seal closure device. Malpositioning of the device led to the ischemic complications. We describe and illustrate the pre- and peroperative findings and the treatment. Interventionalists should monitor and register ischemic complications following the use of puncture site closure devices in order to try and minimize these. The occurrence of few serious complications can outweigh the relative small benefits these devices offer.

Vascular Closure Device: To Close or Not To Close?

“…A recent cost effectiveness study by Resnic et al using a decision analytical model, showed that the routine use of Angio-Seal device post PCI in their institution was associated with 44$ net cost savings per person [7,8]. However it is worth noting that any evaluation of the merits of vascular closure devices should also take into account a trend in the gradual reduction of vascular complications post angiography that has been noted over the last few years [9].…”

Acute arterial occlusion due to vascular closure device: A report of two cases

“…[1,2,5,6] Though recent meta-analyses have failed to demonstrate the clear superiority of VCDs to MC, their use in clinical practice is widely accepted, despite an increase in device-related complications. [4,5,7] MC requires an educated medical staff, manpower, prolonged bed rest, and long-time pressure on the puncture area.…”

“…[4,5,7] MC requires an educated medical staff, manpower, prolonged bed rest, and long-time pressure on the puncture area. [1][2][3]7] To overcome these disadvantages of compression, an alternative was found: closure devices. VCDs offer many advantages, such as immediate hemostasis, successful use in patients who are highly anticoagulated, and early ambulation and hospital discharge.…”

“…[4,5] VCD-related complications have been reported, including access site infection and acute arterial occlusion that may require extra-surgical intervention. [2,3] Herein, 2 cases of limb-threatening ischemic complications following the use of Angio-Seal vascular closure device are reported.…”

“…One of these devices, the Angio-Seal vascular closure device (St. Jude Medical, Inc., St. Paul, MN, USA), consists of a polymer anchor, a small bovine collagen sponge, and a traction suture; all components of the device are absorbed within 60 to 90 days. [1,2] The device seals and compresses the arterial wall between the anchor and the collagen sponge. [3] VCDs have many advantages, such as immediate hemostasis, and early ambulation and hospital discharge.…”