Perclose Closure Device breakage and embolization during deployment followed by retrieval with snare

Abstract

Perclose Closure Device (Abbott-Vascular) was attempted for femoral artery (FA) access site closure by an experienced operator. The device was felt to snap as it was pushed through the previously scarred skin and subcutaneous tissue. Perclose had broken into two pieces with the proximal portion outside the body and the distal portion embolizing to lie in the FA to distal aorta. The left FA was accessed through 8F sheath and 4-8mm Basket snare passed through a 6F multipurpose guiding catheter. The tip of the broken Perclose was caught with the snare and pulled out. The Perclose has a distal flexible sheath that is overmolded directly onto the proximal rigid guide. This junction of sheath and guide may be a weak point. Accidental pressure applied at this weak point in any Perclose device during deployment can cause breakage. Awareness of this rare complication is important for safety.

Inadvertent Insertion of Hemodialysis Catheter into Brachiocephalic Trunk During Cannulation of Internal Jugular Vein: Management Strategies

“…7 An extensive search of literature regarding the incidence of breakage and embolism of Perclose devices yielded only two results. 8,9 In both the cases, the embolized device could be retrieved with snare, without any complication. Jahromi et al have reported thromboembolic stroke after percutaneous treatment of inadvertent subclavian artery placement of a CVC.…”

Watchman Device Procedure Complicated by Rare Perclose ProGlide Embolization: Case Report and Literature Review

“…Embolization of intravascular foreign bodies poses many risks for our patients including the development of perforation, septic complications, thrombosis, and obstruction in blood flow [ 10 ]. In the previous two cases of Perclose ProGlide embolizations, a snare retrieval approach was used to manage this complication [ 5 , 9 ]. In our case, the patient needed to go to the operating room emergently.…”

New approaches to achieving hemostasis after venous access in cardiovascular patients

“…Rarer still, but widely known are reports of Perclose device breakage and embolization despite senior operator experience; in one case this required snaring to retrieve the broken device from the arterial system [57]. Another case required emergency surgery to retrieve the device from the femoral vein [58].…”