Common femoral artery stenosis after deployment of vascular clip closure device

Abstract

We describe a case of symptomatic common femoral artery stenosis following use of a vascular clip closure device (StarClose). Operative repair was performed, with removal of the clip device and subsequent vein patch angioplasty.

The road to perfect closure—Still unpaved

“…The US Food and Drug Administration MAUDE (Manufacturer and User Facility Device Experience) database http:// www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/ search.cfm on VCDs cites 22 deaths in 2007, including 3 related to complications of vascular obstruction (though none of these were after StarClose use), the issue in this month's report by Osborn et al [6]. It should be noted that MAUDE is highly flawed, some of the complications may not have had a causal relationship with VCDs, and the reporting is grossly incompleteboth in terms of numbers actually reported and the quality of the reporting.…”

“…The most common and egregious error is failure to perform a routine angiogram prior to device deployment. However, in the case report by Osborn et al [6], their femoral angiogram is perfect in my estimation. The right anterior oblique view beautifully shows the puncture to be above the femoral bifurcation and well below the inferior epigastric artery; furthermore the puncture site is at the ideal location below the centerline of the femoral head.…”

“…Regarding the report by Osborn et al [6], there have been a small but significant number of reports of vascular obstruction secondary to VCD use in the vascular closure literature. Angio-Seal has been associated with several etiologies of obstruction: obstruction by the anchor or by intraluminal tissue growth around the anchor at the deployment site, by migration of the anchor to the popliteal or infrapopliteal vessels, or by thrombosis secondary to intraarterial placement of collagen.…”

GRID: A high‐resolution protein structure refinement algorithm

“…Acute limb ischemia (ALI) or new‐onset claudication (CI) after PIs as a result of complicated vascular access and/or closure are infrequent conditions [6–9]. However, recently ALI and/or CI were increasingly reported after use of different vascular closure devices (VCD), such as Angio‐Seal (St. Jude Medical, St. Paul, MN) [6–14], Starclose (Abbott Vascular Devices, Redwood City, CA) [15–18], Perclose (Abbott Vascular Devices, Redwood City, CA) [19, 20], and earlier with the Duett device (Vascular Solutions, Minneapolis, MN) [21]. Up to date, only case reports and series including small numbers of patients are published: numbers of patients involved, associated VCD, and resulting treatment are summarized in Table I.…”