Excimer laser-assisted recanalisation of femoral arterial stenosis or occlusion caused by the use of Angio-Seal

Abstract

The aim of this study was to demonstrate the effect of excimer laser and balloon angioplasty of femoral artery stenosis and occlusion after use of a haemostatic puncture closure device. A haemostatic puncture closure device (Angio-Seal) was used in 6000 patients after diagnostic or therapeutic artery catheterisation. In 34 of those patients symptoms of peripheral artery disease occurred. Sixteen of those 34 cases were transferred to our clinic for excimer laser angioplasty. All 16 patients presented with symptoms of acute peripheral artery disease within 1-14 days: superficial femoral artery (SFA) occlusions (4 cases); superficial femoral artery stenosis (3 cases); high-grade stenosis of the common femoral artery (CFA; 3 cases); high-grade stenosis of CFA; SFA and profund femoral artery (PFA; 3 cases); and occlusions of CFA, SFA and PFA (3 cases). Before any procedure was performed, informed consent was given by the patient, which included the use of the Angio-Seal closure device. Every patient who had to undergo recanalisation procedures gave additional informed consent which especially included the usage of the excimer laser for recanalisation. A measurement of the walking distance, ankle-brachial systolic pressure index (ABI) and diagnostic angiography was performed in 13 cases before and immediate after as well as 3 and 6 months after therapeutic percutaneous transluminal laser angioplasty followed by balloon angioplasty (PTLA/PTA). In 3 patients the risks of PTLA/PTA was considered too high; those patients underwent surgical repair. Angiographic and clinical improvement was achieved in 13 of 13 patients. The mean walking distance increased from 81 to > 400 m. The average ankle-brachial systolic pressure index (ABI) increased from 0.47 to 0.84. One patient developed a dissection of the SFA, and in 1 case a peripheral embolisation was seen. The PTLA/PTA technique is a successful therapeutic option for patients with femoral artery occlusion or high-grade stenosis after Angio-Seal application.

Acute and medium‐term outcomes of endovascular therapy of obstructive disease of diverse etiology of the common femoral artery

“…This subset is particularly relevant to interventional cardiologists in the United States where approximately half of all the 1.3 million patients undergoing percutaneous coronary intervention annually receive a VCD [16–19]. Assuming a rate of ALI of 0–0.6% that has been reported in the largest series using these devices is applicable in the general population , and that the majority of these are due to injury to the CFA as suggested by this series, we estimate that up to 8,000 such cases occur in the United States annually. To date, the endovascular treatment of these patients has been largely limited to individual case reports highlighting acute technical success .…”

Carotid stenting and bivalirudin with and without vascular closure: 3‐year analysis of procedural outcomes

“…A meta‐analysis of 2426 patients from 11 studies who had a VCD following an invasive cardiac procedures assessed the incidence of major hemodynamic and clinical complications [28]. There have been several retrospective and observational single‐center studies examining adverse outcome rates, and time to mobilization and discharge, with AngioSeal and Perclose [29–38]. In general, there was significant disparity in reported complication rates, which may have been due to confounders, such as whether procedures were diagnostic or interventional.…”

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

“…Four of the 13 patients had complete vessel occlusion while the remaining 9 had lowerextremity vessel stenosis. All patients were successfully treated and experienced increased walking distance and an improved ankle-brachial index immediately following the procedure and at 3-and 6-month follow-up (19).…”