Angio-Seal™ Embolization: A Rare Etiology of an Acute Distal Limb Ischemia

Abstract

We herein report a serious vascular complication of diagnostic cardiac catheterization due to an embolization of an Angio-Seal closure device causing acute lower limb ischemia. The Angio-Seal was deployed via the right femoral artery following the catheterization which embolized several hours later to the right popliteal artery. Fogarty embolectomy restored perfusion to the right lower limb; however, compartment syndrome subsequently developed which required evacuation of a hematoma and repair of right popliteal artery.

Complications with the use of Angio-Seal vascular closure device and their management

“…There is a report where endovascular retrieval has been attempted successfully; [ 12 ] however, embolectomy is more predictable and likely to have higher chances of successful retrieval of the device. [ 13 , 14 ] The site where the footplate usually lodges after embolization is the popliteal artery or tibioperoneal trunk, these are more likely to be symptomatic and have an early clinical presentation. If detected early, these should be treated with surgical embolectomy, while for a delayed presentation angioplasty can be done.…”

Treatment of Common Femoral Artery Pseudoaneurysm: A Novel Approach Utilizing a VASCADE Percutaneous Closure Device

“…Particularly, the lack of an endovascular component in VASCADE compared with Angio-Seal's endovascular anchor eliminates the concern for foreign body embolization. This complication has been documented to cause acute distal limb ischemia [12, 13]. Elimination of the risk of such a complication, while rare, suggests that exploration of VASCADE's efficacy in pseudoaneurysm treatment may be more appealing than studying Angio-Seal's efficacy.…”

Acute lower limb ischemia following Angio-Seal deployment after transfemoral percutaneous coronary intervention

“…It would be beneficial to determine the cause of intraluminal dislocation of the device. According to other authors we assume that probable causes were inadequate pressure applied to the suture during deployment or placement of the VCD over the atherosclerotic plaque [7]. Both of these scenarios could lead to vessel wall rupture and dislodgment of the device to the distal part of the artery, resulting in limb ischemia.…”