Critical Lower Limb Ischemia from an Embolized Angio-Seal Closure Device

Cianci, Chris; Kowal, Robert C.; Feghali, Georges; Hohmann, Stephen; Stoler, Robert C.; Choi, James W.

doi:10.1080/08998280.2013.11929017

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele (Tsetis 2010;Tonnessen 2011;Keeling et al 2009;Katzenschlager et al 1995;Romaguera et al 2012;Xiong et al 2012;Johnson et al 1994). Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection (Cianci et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

et al. 2020

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Background The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele. Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications. Results Ninety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%. Conclusions The percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.

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Section: Introductionmentioning

confidence: 99%

Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

et al. 2020

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“…[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.…”

Section: Discussionmentioning

confidence: 99%

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

Çelik

Çetinkaya²,

Konca³

et al. 2018

Ulus Travma Acil Cerrahi Derg

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Vascular closure devices are frequently used after percutaneous arterial interventions to achieve hemostasis at the puncture site and facilitate early ambulation. Occasionally, complications have been reported with closure devices, such as hematoma, infection, arteriovenous fistula, pseudoaneurysm, and ischemia. This is a report of 2 cases of severe, acute-onset arterial occlusion and critical limb ischemia, one of which occurred in the upper limb following the use of a vascular closure device, and the required surgical treatment.

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“…17 There was concern about the use of VCDs because of few reported serious complications. [18][19][20][21] However, if complications were looked in big series VCDs were found to be safe. Major complications were reported from 0% in this study and others 12 À1.5%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Angioseal and Manual Compression in Patients Undergoing Transfemoral Coronary and Peripheral Vascular Interventional Procedures

Alshehri

Elsharawy

2015

Int J Angiol

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Vascular closure devices (VCDs) were introduced in the early 1990s with the goal of limiting the time, labor, bed rest, and patient discomfort associated with manual compression (MC) for hemostasis after cardiovascular interventions. However, its advantage over MC has not been extensively studied after interventional procedures. The aim of this study was to do prospective, randomized study comparing the safety and efficacy of the Angio-Seal (AS) to that of MC in patients undergoing transfemoral coronary and peripheral vascular interventional procedure. A prospective, randomized trial was undertaken on consecutive series of patients admitted to King Fahd Hospital of the University for transfemoral coronary and peripheral vascular interventional procedures over 1 year. The study was designed to compare the hemostasis time in minutes and the incidence of vascular complications in patients receiving AS with those undergoing MC. All patients were on antiplatelets and received heparin during the procedure. During the study period, 160 patients were included, 80 in each group. There was a significant difference in mean time to hemostasis in minutes (15.83 ± 1.63 minutes for MC and 0.42 ± 0.04 minutes for the AS; p < 0.001), time to ambulation in minutes (280 ± 15 for MC and 120 for AS; p = 0.04) and in minor complications (33.8% in MC vs. AS 5%; p < 0.001). However, the major complication rate did not significantly differ between the two groups (0% in AS vs. 2.5% in MC; p = 0.15). AS was found to achieve rapid closure of the femoral access site safely in patients undergoing coronary and peripheral vascular interventional procedures under antiplatelets and systemic heparinization.

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Critical Lower Limb Ischemia from an Embolized Angio-Seal Closure Device

Cited by 5 publications

References 18 publications

Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

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

Comparison of Angioseal and Manual Compression in Patients Undergoing Transfemoral Coronary and Peripheral Vascular Interventional Procedures

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