Angio-Seal in Antegrade Endovascular Interventions: Technical Success and Complications in a 55-Patient Series

Abstract

¤ ¤Purpose: To assess the technical success and complications of Angio-Seal vascular closure device in antegrade common femoral artery (CFA) punctures.Methods: Over a 14-month period, 55 patients (37 men; age range 37-94 years) underwent antegrade CFA Angio-Seal placement at a single center; the clinical data and angiograms were reviewed retrospectively. A total of 56 antegrade CFA punctures were made for hemostasis; 6-F Angio-Seal devices (40 model STS and 12 model VIP) were deployed in 52 CFAs, and 8-F Angio-Seal devices were deployed in 4. Results:The technical success rate was 98.2% (55/56). Two (3.6%) patients developed small, non-expanding hematomas (,5 cm) during deployment of the device. There was 1 episode of device/operator failure, presumably due to extravascular deployment within soft tissue. None of the patients developed pseudoaneurysm, arterial injury, or large hematomas requiring transfusion. Small calcified plaques at the puncture site did not influence the outcome.Conclusion: This series suggests that Angio-Seal may be a safe and effective device for hemostasis in antegrade CFA punctures. Further randomized trials testing its risk-benefit balance in comparison to standard manual compression are warranted.

Safety and Efficacy of the StarClose Vascular Closure System Using 7-F and 8-F Sheath Sizes:A Consecutive Single-Center Analysis

“…Arterial closures with the 8-F AngioSeal or Perclose ProGlide have been safe and effective in achieving immediate hemostasis in fully anticoagulated patients after peripheral interventional procedures using an antegrade or a retrograde approach. [5][6][7][8][9][10][11] These devices, however, have a small but significant number of disadvantages. For example, suture-mediated devices suffer from imprecise placement of suture, with consequent inadequate closure and narrowing of the vessel, 12 or groin infections that require drainage of the abscess, removal of the suture, and repair of the vessel.…”

Comparison of Arterial Closure Devices in Antegrade and Retrograde Punctures

“…For the Angio-Seal device, there have been only 3 case series discussing ¤ ¤ 9 Minor complications (2 hematomas) occurred in 3.6% of the patients who underwent device insertion. Mukhopadhyay et al 10 studied 21 antegrade punctures and found a 9.4% complication rate, which included a hematoma and 1 case of ischemia.…”

Risk factors for femoral arterial complications and management

“…Perclose, using two 6-F devices for "preclosure, " and Prostar XL are particularly well positioned in this respect, and there are some excellent descriptive series showing a high success rate, despite use of sheaths up to 24 F. 7 There is increasing interest in closure of antegrade femoral punctures, and a number of studies have described use of many of the previously mentioned devices, albeit offlabel. [8][9][10] Similarly, there is additional interest in using VCDs off-label for the brachial approach, although the limited depth of the arteriotomy should exclude a number of devices from consideration. 11 Overall, I am aware of a half dozen VCDs making their way through bench, animal, and human testing, and I expect to have a number of other devices to discuss in the next installment of this column.…”