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Angio-Seal™ Embolization: A Rare Etiology of an Acute Distal Limb Ischemia. Case Rep Vasc Med 2017; 2017:9613863. [PMID: 29181220 PMCID: PMC5664249 DOI: 10.1155/2017/9613863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/01/2017] [Accepted: 09/17/2017] [Indexed: 11/21/2022] Open
Abstract
We herein report a serious vascular complication of diagnostic cardiac catheterization due to an embolization of an Angio-Seal closure device causing acute lower limb ischemia. The Angio-Seal was deployed via the right femoral artery following the catheterization which embolized several hours later to the right popliteal artery. Fogarty embolectomy restored perfusion to the right lower limb; however, compartment syndrome subsequently developed which required evacuation of a hematoma and repair of right popliteal artery.
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Robertson L, Andras A, Colgan F, Jackson R. Vascular closure devices for femoral arterial puncture site haemostasis. Cochrane Database Syst Rev 2016; 3:CD009541. [PMID: 26948236 PMCID: PMC10372718 DOI: 10.1002/14651858.cd009541.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vascular closure devices (VCDs) are widely used to achieve haemostasis after procedures requiring percutaneous common femoral artery (CFA) puncture. There is no consensus regarding the benefits of VCDs, including potential reduction in procedure time, length of hospital stay or time to patient ambulation. No robust evidence exists that VCDs reduce the incidence of puncture site complications compared with haemostasis achieved through extrinsic (manual or mechanical) compression. OBJECTIVES To determine the efficacy and safety of VCDs versus traditional methods of extrinsic compression in achieving haemostasis after retrograde and antegrade percutaneous arterial puncture of the CFA. SEARCH METHODS The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (April 2015) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 3). Clinical trials databases were searched for details of ongoing or unpublished studies. References of articles retrieved by electronic searches were searched for additional citations. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials in which people undergoing a diagnostic or interventional procedure via percutaneous CFA puncture were randomised to one type of VCD versus extrinsic compression or another type of VCD. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the methodological quality of trials. We resolved disagreements by discussion with the third author. We performed meta-analyses when heterogeneity (I(2)) was < 90%. The primary efficacy outcomes were time to haemostasis and time to mobilisation (mean difference (MD) and 95% confidence interval (CI)). The primary safety outcome was a major adverse event (mortality and vascular injury requiring repair) (odds ratio (OR) and 95% CI). Secondary outcomes included adverse events. MAIN RESULTS We included 52 studies (19,192 participants) in the review. We found studies comparing VCDs with extrinsic compression (sheath size ≤ 9 Fr), different VCDs with each other after endovascular (EVAR) and percutaneous EVAR procedures and VCDs with surgical closure after open exposure of the artery (sheath size ≥ 10 Fr). For primary outcomes, we assigned the quality of evidence according to GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria as low because of serious imprecision and for secondary outcomes as moderate for precision, consistency and directness.For time to haemostasis, studies comparing collagen-based VCDs and extrinsic compression were too heterogenous to be combined. However, both metal clip-based (MD -14.81 minutes, 95% CI -16.98 to -12.63 minutes; five studies; 1665 participants) and suture-based VCDs (MD -14.58 minutes, 95% CI -16.85 to -12.32 minutes; seven studies; 1664 participants) were associated with reduced time to haemostasis when compared with extrinsic compression.For time to mobilisation, studies comparing collagen-, metal clip- and suture-based devices with extrinsic compression were too heterogeneous to be combined. No deaths were reported in the studies comparing collagen-based, metal clip-based or suture-based VCDs with extrinsic compression. For vascular injury requiring repair, meta-analyses demonstrated that neither collagen (OR 2.81, 95% CI 0.47 to 16.79; six studies; 5731 participants) nor metal clip-based VCDs (OR 0.49, 95% CI 0.03 to 7.95; three studies; 783 participants) were more effective than extrinsic compression. No cases of vascular injury required repair in the study testing suture-based VCD with extrinsic compression.Investigators reported no differences in the incidence of infection between collagen-based (OR 2.14, 95% CI 0.88 to 5.22; nine studies; 7616 participants) or suture-based VCDs (OR 1.66, 95% CI 0.22 to 12.71; three studies; 750 participants) and extrinsic compression. No cases of infection were observed in studies testing suture-based VCD versus extrinsic compression. The incidence of groin haematoma was lower with collagen-based VCDs than with extrinsic compression (OR 0.46, 95% CI 0.40 to 0.54; 25 studies; 10,247 participants), but no difference was evident when metal clip-based (OR 0.79, 95% CI 0.46 to 1.34; four studies; 1523 participants) or suture-based VCDs (OR 0.65, 95% CI 0.41 to 1.02; six studies; 1350 participants) were compared with extrinsic compression. The incidence of pseudoaneurysm was lower with collagen-based devices than with extrinsic compression (OR 0.74, 95% CI 0.55 to 0.99; 21 studies; 9342 participants), but no difference was noted when metal clip-based (OR 0.76, 95% CI 0.20 to 2.89; six studies; 1966 participants) or suture-based VCDs (OR 0.79, 95% CI 0.25 to 2.53; six studies; 1527 participants) were compared with extrinsic compression. For other adverse events, researchers reported no differences between collagen-based, clip-based or suture-based VCDs and extrinsic compression.Limited data were obtained when VCDs were compared with each other. Results of one study showed that metal clip-based VCDs were associated with shorter time to haemostasis (MD -2.24 minutes, 95% CI -2.54 to -1.94 minutes; 469 participants) and shorter time to mobilisation (MD -0.30 hours, 95% CI -0.59 to -0.01 hours; 469 participants) than suture-based devices. Few studies measured (major) adverse events, and those that did found no cases or no differences between VCDs.Percutaneous EVAR procedures revealed no differences in time to haemostasis (MD -3.20 minutes, 95% CI -10.23 to 3.83 minutes; one study; 101 participants), time to mobilisation (MD 1.00 hours, 95% CI -2.20 to 4.20 hours; one study; 101 participants) or major adverse events between PerClose and ProGlide. When compared with sutures after open exposure, VCD was associated with shorter time to haemostasis (MD -11.58 minutes, 95% CI -18.85 to -4.31 minutes; one study; 151 participants) but no difference in time to mobilisation (MD -2.50 hours, 95% CI -7.21 to 2.21 hours; one study; 151 participants) or incidence of major adverse events. AUTHORS' CONCLUSIONS For time to haemostasis, studies comparing collagen-based VCDs and extrinsic compression were too heterogeneous to be combined. However, both metal clip-based and suture-based VCDs were associated with reduced time to haemostasis when compared with extrinsic compression. For time to mobilisation, studies comparing VCDs with extrinsic compression were too heterogeneous to be combined. No difference was demonstrated in the incidence of vascular injury or mortality when VCDs were compared with extrinsic compression. No difference was demonstrated in the efficacy or safety of VCDs with different mechanisms of action. Further work is necessary to evaluate the efficacy of devices currently in use and to compare these with one other and extrinsic compression with respect to clearly defined outcome measures.
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Affiliation(s)
- Lindsay Robertson
- Freeman HospitalDepartment of Vascular SurgeryNewcastle upon Tyne Hospitals NHS Foundation TrustHigh HeatonNewcastle upon TyneUKNE7 7DN
| | - Alina Andras
- Keele University, Guy Hilton Research CentreInstitute for Science and Technology in MedicineThornburrow DriveHartshillStoke‐on‐TrentUKST4 7QB
- Freeman HospitalNorthern Vascular CentreNewcastle upon TyneUKNE7 7DN
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Simplified swift and safe vascular closure device deployment without a local arteriogram: Single center experience in 2074 consecutive patients. Indian Heart J 2016; 68:529-38. [PMID: 27543479 PMCID: PMC4990740 DOI: 10.1016/j.ihj.2015.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 11/23/2022] Open
Abstract
Objective Vascular closure devices (VCDs), such as the Angio-Seal, a three-component hemostatic plug, have greatly facilitated the routine clinical practice in the catheterization laboratory. The manufacturer recommends a local angiogram before Angio-Seal deployment. However, from the outset, we employed a simplified routine of deploying this VCD, i.e. without use of local angiography. Methods The Angio-Seal was employed without a preceding femoral arteriogram over 8 years in 2074 consecutive patients, 72% presenting with acute coronary syndromes and subjected to coronary angiography (n = 1032) or PCI n = 1042) via a transfemoral approach with use of heparin and dual antiplatelet therapy. Results Deployment of the VCD was successful in 99.4%. Complete hemostasis was obtained in 98% of cases. In 14 patients, Angio-Seal deployment failed. Mean time for placement of Angio-Seal was <1 min, to-hemostasis 1 min, and to-mobilization 3 h. Only 3 (0.15%) patients had a major complication with vessel occlusion that required emergent vascular surgery with a successful outcome. Two patients developed a local pseudoaneurysm treated with ultrasonography-guided compression. Six small and 4 large inguinal hematomas (one requiring blood transfusion) and 5 cases of retroperitoneal bleeding (one requiring blood transfusion) were recorded. Conclusion Deployment of Angio-Seal without use of local angiography was efficacious and safe, characterized by a high success rate of deployment and hemostasis with few correctable complications in a large patient cohort undergoing transfemoral catheterization for PCI and non-PCI procedures under anticoagulation and antiplatelet drug therapy. VCD reduced the time-to-hemostasis and time-to-mobilization and minimized the incidence of complications.
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Jiang J, Zou J, Ma H, Jiao Y, Yang H, Zhang X, Miao Y. Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis. Sci Rep 2015; 5:13761. [PMID: 26349075 PMCID: PMC4562233 DOI: 10.1038/srep13761] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/05/2015] [Indexed: 11/09/2022] Open
Abstract
The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.
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Affiliation(s)
- Jun Jiang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Junjie Zou
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Hao Ma
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Yuanyong Jiao
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Hongyu Yang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Xiwei Zhang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Yi Miao
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
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Wu PJ, Dai YT, Kao HL, Chang CH, Lou MF. Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for haemostasis. BMC Cardiovasc Disord 2015; 15:34. [PMID: 25956814 PMCID: PMC4434571 DOI: 10.1186/s12872-015-0022-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 04/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vascular closure devices such as angioseal are used as alternatives to traditional compression haemostasis. Although the safety and efficacy of angioseal are confirmed, their use remains controversial because of the potential complications of these devices compared with those of traditional compression haemostasis. The aim of this study was to compare the access site complication rate, the predictive factors for these complications, and patient comfort levels after coronary procedures with traditional compression or angioseal haemostasis. METHODS Data were collected from a cardiac unit in a medical center in northern Taiwan. A total of 130 adult patients were recruited and equally divided into two groups according to the method of haemostasis used after the coronary procedure: a traditional compression group and an angioseal group. We observed the incidence of access site complications, including bleeding, oozing, haematoma formation, and arteriovenous fistula formation. In addition, we used a 0-10 numeric rating scale to assess soreness, numbness, and back and groin access site pain after 1 h of catheter removal and immediately before getting out of bed. RESULTS The overall incidence of complications was 3.8 % (n = 5), which was not significantly different between the two groups (p = .06). The propensity score--adjusted multivariate analyses revealed that the only independent predictor for access site complications was an age of >70 years (OR, 10.44; 95 % CI, 1.81-60.06; p = .009). Comfort levels were higher in the angioseal group than in the traditional compression group. CONCLUSIONS Angioseal used after coronary procedures did not increase the incidence of complications relative to that associated with traditional compression haemostasis; however, it increased patient comfort levels. Health personnel should pay special attention to the predictive factor for access site complications after coronary procedures, such as age >70 years.
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Affiliation(s)
- Pei-Jung Wu
- Department of Nursing, Taipei Veterans General Hospital, 201, Sec. 2, Shipai Road, Taipei City, 11217, Taiwan.
| | - Yu-Tzu Dai
- School of Nursing, College of Medicine, National Taiwan University, 1, Sec. 1, Jen-Ai Road, Taipei City, 10063, Taiwan.
| | - Hsien-Li Kao
- Department of Internal Medicine, College of Medicine, National Taiwan University, 1, Sec. 1, Jen-Ai Road, Taipei City, 10063, Taiwan. .,Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital, 7, Chung Shan S. Rd., Taipei City, 10002, Taiwan.
| | - Chin-Hao Chang
- Department of Medicine Research, National Taiwan University Hospital, 7, Chung Shan S. Rd., Taipei City, 10002, Taiwan.
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, 1, Sec. 1, Jen-Ai Road, Taipei City, 10063, Taiwan.
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Cho JH, Lee HK. Evaluation of the method of hemostasis after femoral arterial puncture. J Phys Ther Sci 2014; 26:955-9. [PMID: 25140073 PMCID: PMC4135214 DOI: 10.1589/jpts.26.955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/08/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study assessed the advantages and shortcomings of methods for hemostasis
in patients who had received angiography after femoral arterial puncture using manual,
compression device, or a combination of manual compression and a compression device. In
addition, the success rates, complications, etc, were analyzed. [Subjects and Methods] One
hundred and eighty patients who had undergone angiography after femoral arterial puncture
were divided into three groups according to the method of hemostasis. For group A,
immediately after angiography, an Angio-Seal device was placed in the puncture area and
compressed using a compression device. For group B, after angiography, the puncture area
was compressed with the hands directly. For group C, the puncture area was compressed
using a compression device for approximately 10 min, and the puncture area was then
compressed with the hands. In each group, the following correlations were analyzed: the
time to hemostasis after angiography and gender, the time to hemostasis of each generation
and the hemoglobin value, and platelet value and the time to hemostasis. [Results] The
results showed a similar time to hemostasis regardless of gender or generation. The
correlation between the hemoglobin value, platelet value, and the time to hemostasis were
not significant. Group A showed the shortest mean time to hemostasis of the three groups
(20.37 ± 8.23 min). No complications caused by the hemostasis method were detected in
group B. Group A showed the highest incidence of complications caused by hemostasis.
[Conclusion] Overall, hemostasis performed mutually is safe and effective for patients
according to their condition.
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Affiliation(s)
- Jae-Hwan Cho
- Department of International Radiological Science, Hallym University of Graduate Studies, Republic of Korea
| | - Hae-Kag Lee
- Department of Computer Science and Engineering, Soonchunhyang University, Republic of Korea
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Vascular closure device failure in contemporary practice. JACC Cardiovasc Interv 2013; 5:837-44. [PMID: 22917455 DOI: 10.1016/j.jcin.2012.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 04/12/2012] [Accepted: 05/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The goal of this study was to assess the frequency and predictors of vascular closure device (VCD) deployment failure, and its association with vascular complications of 3 commonly used VCDs. BACKGROUND VCDs are commonly used following percutaneous coronary intervention on the basis of studies demonstrating reduced time to ambulation, increased patient comfort, and possible reduction in vascular complications as compared with manual compression. However, limited data are available on the frequency and predictors of VCD failure, and the association of deployment failure with vascular complications. METHODS From a de-identified dataset provided by Massachusetts Department of Health, 23,813 consecutive interventional coronary procedures that used either a collagen plug-based (n = 18,533), a nitinol clip-based (n = 2,284), or a suture-based (n = 2,996) VCD between June 2005 and December 2007 were identified. The authors defined VCD failure as unsuccessful deployment or failure to achieve immediate access site hemostasis. RESULTS Among 23,813 procedures, the VCD failed in 781 (3.3%) procedures (2.1% of collagen plug-based, 6.1% of suture-based, 9.5% of nitinol clip-based VCDs). Patients with VCD failure had an excess risk of "any" (7.7% vs. 2.8%; p < 0.001), major (3.3% vs. 0.8%; p < 0.001), or minor (5.8% vs. 2.1%; p < 0.001) vascular complications compared with successful VCD deployment. In a propensity score-adjusted analysis, when compared with collagen plug-based VCD (reference odds ratio [OR] = 1.0), nitinol clip-based VCD had 2-fold increased risk (OR: 2.0, 95% confidence interval [CI]: 1.8 to 2.3, p < 0.001) and suture-based VCD had 1.25-fold increased risk (OR: 1.25, 95% CI: 1.2 to 1.3, p < 0.001) for VCD failure. VCD failure was a significant predictor of subsequent vascular complications for both collagen plug-based VCD and nitinol clip-based VCD, but not for suture-based VCD. CONCLUSIONS VCD failure rates vary depending upon the type of VCD used and are associated with significantly higher vascular complications as compared with deployment successes.
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Sarin SN, Shah RK, Chun A, Akman A, Arora S, Rahbar R, Neville R, Venbrux AC. Use of the 8-F Angio-Seal Vascular Closure Device in Large-Caliber Arteriotomies. J Endovasc Ther 2012; 19:497-500. [DOI: 10.1583/12-3881.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Georg Y, Thaveau F, Lejay A, Bajcz C, Bakassa S, Chakfe N, Kretz JG. Arterial thrombosis after using Angio-Seal. Ann Vasc Surg 2012; 25:1078-93. [PMID: 22023942 DOI: 10.1016/j.avsg.2010.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 10/04/2010] [Accepted: 11/09/2010] [Indexed: 12/17/2022]
Abstract
Percutaneous closure systems of arterial puncture sites are being used more and more in modern endovascular practice. In this article, we report five cases of thrombotic complications following Angio-Seal deployment which required to be treated in our department between June 2004 and January 2006. We carried out a computerized literature review using "vascular closure" as a keyword and elected 106 articles published between 1992 and 2007. The analysis of this literature review showed that the rate of percutaneous closure complications was similar to the rate of manual compression complications, which is still the reference method. The complications associated with the use of these systems were more complex and more often required surgical repair. The severity and frequency of these complications differ based on the type of closure systems. The vascular surgeon in charge must have a good knowledge of these systems and of the complications each of them entails to be able to treat them in the most appropriate way.
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Affiliation(s)
- Yannick Georg
- Service de Chirurgie Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
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Wanitschek MM, Suessenbacher A, Dörler J, Pachinger O, Moes N, Alber HF. Safety and efficacy of femoral artery closure with the FemoSeal® device after coronary angiography using a 7 French sheath. Perfusion 2011; 26:447-52. [DOI: 10.1177/0267659111409967] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-cardiac catheterization femoral artery hemostasis can be accomplished with several mechanisms, including the FemoSeal® hemostasis device which has been designed and approved for closure of 6 French (F) arterial puncture sites. The aim of this study was to investigate whether the FemoSeal® vascular closure device can effectively and safely seal 7F arterial puncture sites after diagnostic and interventional cardiac catheterizations. Femoral artery puncture sites of 50 consecutive patients undergoing cardiac catheterization were closed with the FemoSeal® vascular closure device, according to the manufacturer’s instructions. Efficacy endpoints were time to hemostasis and successful ambulation. Safety endpoints included bleeding complications, vessel occlusion and pseudoaneurysms. Mean time to hemostasis was 57.8±26.3 seconds (0-125 seconds). Hemostasis was achieved in 100 percent of the 50 patients. One patient suffered minor bleeding the next day, i.e. local hematoma. This clinical study demonstrates that the FemoSeal® vascular closure device, initially approved for closure of 6F arterial puncture sites, shows promising efficacy and safety to seal a larger (7F) femoral arterial puncture sites after diagnostic and interventional cardiac catheterizations.
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Affiliation(s)
- MM Wanitschek
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - A Suessenbacher
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - J Dörler
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - O Pachinger
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - N Moes
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - HF Alber
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
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Biancari F, D'Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J 2010; 159:518-31. [PMID: 20362708 DOI: 10.1016/j.ahj.2009.12.027] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 12/14/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this meta-analysis was to evaluate the safety and efficacy of vascular closure devices (VCDs). METHODS This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews. RESULTS The literature search yielded 31 prospective, randomized studies including 7,528 patients who were randomized to VCDs or manual/mechanical compression after diagnostic angiography and/or endovascular procedures. Most of these studies have excluded patients at high risk of puncture site complications. Meta-analysis showed similar results in the study groups in terms of groin hematoma, bleeding, pseudoaneurysm, and blood transfusion. Lower limb ischemia and other arterial ischemic complications (0.3% vs 0%, P = .07) as well as need of surgery for vascular complications (0.7% vs 0.4%, P = .10) were somewhat more frequent with arterial puncture closure devices. The incidence of groin infection was significantly more frequent with VCDs (0.6% vs 0.2%, P = .02). The use of VCD was uniformly associated with a significantly shorter time to hemostasis. Such differences where more evident in patients undergoing percutaneous coronary intervention, whereas these methods were associated with similar rates of adverse events among patients undergoing diagnostic coronary angiography. CONCLUSIONS The use of VCDs is associated with a significantly shorter time to hemostasis and thus may shorten recovery. However, the use of VCDs is associated with a somewhat increased risk of infection, lower limb ischemia/arterial stenosis/device entrapment in the artery, and need of vascular surgery for arterial complications. Further studies are needed to get more conclusive results, particularly in patients at high risk of femoral puncture-related complications.
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Affiliation(s)
- Fausto Biancari
- Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
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Hon LQ, Ganeshan A, Thomas SM, Warakaulle D, Jagdish J, Uberoi R. Vascular Closure Devices: A Comparative Overview. Curr Probl Diagn Radiol 2009; 38:33-43. [DOI: 10.1067/j.cpradiol.2008.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation. INT J EVID-BASED HEA 2008. [DOI: 10.1097/01258363-200812000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chair SY, Fernandez R, Lui MHL, Lopez V, Thompson DR. The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation. INT J EVID-BASED HEA 2008; 6:352-90. [DOI: 10.1111/j.1744-1609.2008.00111.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lai YC, Kao HL, Lin YH, Lin MS, Ho YL, Chao CL. The Angio-Seal arterial closure device for early ambulation after elective percutaneous coronary intervention in patients receiving low-dose enoxaparin. J Int Med Res 2008; 36:1077-84. [PMID: 18831904 DOI: 10.1177/147323000803600527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the efficacy and safety of use of the Angio-Seal vascular closure device deployment for early ambulation (2 h) after elective percutaneous coronary intervention in 143 consecutive patients receiving either intravenous low-dose enoxaparin (0.5 mg/kg) or unfractionated heparin (UFH). The initial success rate of Angio-Seal(trade mark) deployment was 98.6%, with no significant difference between the UFH group (98.9%) and the enoxaparin group (98.0%). In-hospital and clinic outcomes were evaluated in the 141 patients with successful Angio-Seal deployment. During hospitalization, there were no deaths, myocardial infarction, urgent target vessel revascularization or bleeding events in either group; three patients in the UFH group and none in the enoxaparin group had minor vascular complications (differences not significant). In clinic follow-up, two patients in the UFH group and none in the enoxaparin group had major vascular complications (differences not significant). Routine use of the Angio-Seal(trade mark) for early ambulation in patients receiving intravenous low-dose enoxaparin compared with UFH provides promising efficacy and safety for daily practice.
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Affiliation(s)
- Y-C Lai
- Division of Cardiology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
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Efficacy and Safety of the Angioseal Vascular Closure Device Post Antegrade Puncture. Cardiovasc Intervent Radiol 2008; 31:558-62. [PMID: 18253787 DOI: 10.1007/s00270-007-9281-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/16/2007] [Accepted: 05/21/2007] [Indexed: 10/22/2022]
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Chair SY, Fernandez R, Lui MHL, Lopez V, Thompson DR. The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation. ACTA ACUST UNITED AC 2008; 6:112-164. [PMID: 27819887 DOI: 10.11124/01938924-200806030-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications. OBJECTIVES The objective of this review was to present the best available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest. SEARCH STRATEGY We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO, Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in the field. SELECTION CRITERIA All randomised and quasi-randomised controlled trials that compared the effects of different lengths of bed rest following trans-femoral diagnostic cardiac catheterisation on patient outcomes were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Odds ratios (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately. MAIN RESULTS Eighteen trials involving a total of 4294 participants were included in the review. One trial included three treatment groups. In seven trials among 747 people there was no significant difference in the incidence of bleeding following six or less than 6 h of bed rest (OR 1.47; 95% CI 0.60, 3.64). Likewise, there was no significant difference in the incidence of bleeding following bed rest at other time periods. In eight trials involving 2272 patients there was no significant difference in the incidence of haematoma formation following 6 or less than 6 h of bed rest (OR 0.82; 95% CI 0.59, 1.16). Significantly fewer patients randomised to less than 6 h of bed rest complained of back pain. The odds of developing back pain at 4 (OR 24.60; 95% CI 1.29, 469) and 24 h (OR 2.47; 95% CI 1.16, 5.23) following coronary catheterisation was significantly higher among patients randomised to 6 compared with 3 h of bed rest. AUTHORS' CONCLUSIONS There is evidence of no benefit relating to bleeding and haematoma formation in patients who have more than 3 h of bed rest following trans-femoral diagnostic cardiac catheterisation. However, there is evidence of benefit relating to decreased incidence and severity of back pain and cost-effectiveness following 3 h of bed rest. There is suggestive but inconclusive evidence of a benefit from bed rest for 2 h following trans-femoral cardiac catheterisation. Clinicians should consider a balance between avoiding increased risk of haematoma formation following 2-2.5 h of bed rest and circumventing back pain following more than 4 h of bed rest.
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Affiliation(s)
- Sek Ying Chair
- 1. The Nethersole School of Nursing, The Chinese University of Hong Kong and The Hong Kong Centre for Evidence Based Nursing: a collaborating centre of the Joanna Briggs Institute, Hong Kong, China 2. South Western Sydney Centre for Applied Nursing Research, Liverpool 3. University of Western Sydney, Parramatta, NSW, Australia 4. Australian Catholic University, School of Nursing, North Sydney, NSW, Australia 5. Department of Health Sciences, University of Leicester, Leicester, UK
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Ratnam LA, Raja J, Munneke GJ, Morgan RA, Belli AM. Prospective Nonrandomized Trial of Manual Compression and Angio-Seal and Starclose Arterial Closure Devices in Common Femoral Punctures. Cardiovasc Intervent Radiol 2007; 30:182-8. [PMID: 17200896 DOI: 10.1007/s00270-006-0226-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We compared the use of manual compression and Angio-Seal and Starclose arterial closure devices to achieve hemostasis following common femoral artery (CFA) punctures in order to evaluate safety and efficacy. A prospective nonrandomized, single-center study was carried out on all patients undergoing CFA punctures over 1 year. Hemostasis was achieved using manual compression in 108 cases, Angio-Seal in 167 cases, and Starclose in 151 cases. Device-failure rates were low and not significantly different in the two groups (manual compression and closure devices; p = 0.8). There were significantly more Starclose (11.9%) patients compared to Angio-Seal (2.4%), with successful initial deployment subsequently requiring additional manual compression to achieve hemostasis (p < 0.0001). A significant number of very thin patients failed to achieve hemostasis (p = 0.014). Major complications were seen in 2.9% of Angio-Seal, 1.9% of Starclose, and 3.7% of manual compression patients, with no significant difference demonstrated; 4.7% of the major complications were seen in female patients compared to 1.3% in males (p = 0.0415). All three methods showed comparable safety and efficacy. Very thin patients are more likely to have failed hemostasis with the Starclose device, although this did not translate into an increased complication rate. There is a significant increased risk of major puncture-site complications in women with peripheral vascular disease.
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Affiliation(s)
- Lakshmi A Ratnam
- Department of Radiology, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
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Aksoy M, Becquemin JP, Desgranges P, Allaire E, Kobeiter H. The Safety and Efficacy of Angioseal in Therapeutic Endovascular Interventions. Eur J Vasc Endovasc Surg 2006; 32:90-3. [PMID: 16478672 DOI: 10.1016/j.ejvs.2005.12.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2005] [Accepted: 12/07/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of the closure device Angioseal. MATERIAL AND METHODS All consecutive patients, who underwent a therapeutic radiological intervention using the femoral artery approach from January 2001 to January 2005 in the Service of Vascular Surgery, Henri Mondor Hospital, Creteil, France, were prospectively included in the study. The efficacy of Angioseal was defined by the ability of the device to cover the puncture site and stop bleeding. The safety was defined by the rate of complications. RESULTS A total of 79 Angioseal devices were employed on 77 patients. There were 62 (78.5%) males and 17 (21.5%) females. The mean age of the patients was 65.2+/-11.6 years (mean+/-SD). All Angioseal devices were deployed successfully. There were 62 (78.4%) 6F and 17 (21.6%) 8F sheaths employed during the procedures. There were two minor (2.5%) hematomas, one (1.2%) major hematoma and one (1.2%) pseudoaneurysm after the procedure. The mean time of discharge from the hospital was 2.1+/-1.8 (mean+/-SD) days. The patients were followed up for a mean of 9.0+/-9.3 (1-60 months) months. CONCLUSIONS Angioseal provides a safe and effective way of closing the femoral artery puncture site with acceptable morbidity rates.
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Affiliation(s)
- M Aksoy
- Department of General Surgery, Medical Faculty of Istanbul, Istanbul, Turkey.
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Wille J, Vos JA, Overtoom TTC, Suttorp MJ, van de Pavoordt EDWM, de Vries JPPM. Acute Leg Ischemia: The Dark Side of a Percutaneous Femoral Artery Closure Device. Ann Vasc Surg 2006; 20:278-81. [PMID: 16550481 DOI: 10.1007/s10016-006-9005-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Revised: 02/12/2005] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization has become widespread because of their proven feasibility in combination with patient-related advantages. Since 2002 more than 6,500 patients have undergone either diagnostic angiography or therapeutic intervention via the femoral route with an Angioseal closure device in our hospital. We were faced with six cases of limb-threatening complications, which are described here. Most (5/6) complications were of obstructive origin due to traumatic dissection or occlusion of the artery mainly caused by malpositioning of the device. Recommendations are made in order to prevent or successfully overcome this certainly increasing problem in the vascular field.
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Affiliation(s)
- Jan Wille
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Mukhopadhyay K, Puckett MA, Roobottom CA. Efficacy and complications of Angioseal in antegrade puncture. Eur J Radiol 2005; 56:409-12. [PMID: 16298678 DOI: 10.1016/j.ejrad.2005.03.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 03/07/2005] [Accepted: 03/09/2005] [Indexed: 11/29/2022]
Abstract
AIM Although arterial closure devices are in use for over a decade, there have been no specific study to assess the use of the same in antegrade puncture. MATERIAL AND METHOD Consecutive patients undergoing antegrade puncture for peripheral vascular disease in a single centre performed by a single operator were included in this study. The notes and the angiograms were reviewed retrospectively for possible complications and the severity of disease. RESULT Over a 25-month period, 21 patients with antegrade puncture had Angioseal deployed for haemostasis. Post-procedure complications recorded from the case notes showed one episode of haematoma formation and one case of worsening ischaemia. The severity of the disease at the puncture site did not influence the outcome. CONCLUSION Use of Angioseal is safe and effective in antegrade punctures for peripheral vascular disease. The result is independent of the severity of disease at the puncture site.
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Slagboom T, Kiemeneij F, Laarman GJ, van der Wieken R. Outpatient coronary angioplasty: Feasible and safe. Catheter Cardiovasc Interv 2005; 64:421-7. [PMID: 15789393 DOI: 10.1002/ccd.20313] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. The purpose of this approach includes cost-effectiveness and patient comfort. Six hundred forty-four patients were randomized to either transradial or transfemoral PTCA using 6 Fr equipment. Patients were triaged to outpatient management based on a predefined set of predictors of an adverse outcome in the first 24 hr after initially successful coronary angioplasty. Three hundred seventy-five patients (58%) were discharged 4-6 hr after PTCA; 42% stayed in hospital overnight. In the outpatient group, one adverse event occurred (subacute stent thrombosis 7 hr postdischarge, nonfatal myocardial infarction). There were no major vascular complications. In the hospital group, 19 patients (7%) sustained an adverse cardiac even in the first 24 hr; 1 patient died. Patients treated via the femoral route had more (minor) bleeding complications (19 patients; 6%); in 17 of these, this was the sole reason that discharge was delayed. PTCA on an outpatient basis, performed via the radial or the femoral artery with low-profile equipment, is safe and feasible in a considerable part of a routine PTCA population. A larger proportion of transradial patients can be discharged due to a reduction in (minor) bleeding complications.
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Affiliation(s)
- Ton Slagboom
- Amsterdam Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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23
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Railo M, Roth WD. The Use of a Collagen-Based Puncture Closure Device in the Subclavian Artery After Inadvertent Introduction of an 11.5 French Hemodialysis Catheter. Cardiovasc Intervent Radiol 2004; 27:681-2. [PMID: 15578147 DOI: 10.1007/s00270-004-0215-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND As vascular surgeons perform increasing numbers of percutaneous catheter-based procedures, they will need to become familiar with varying methods of femoral artery closure. Few studies on closure devices have included significant numbers of patients with peripheral arterial disease. It is the purpose of this study to determine whether the Angioseal device (St. Jude Medical) is a satisfactory method of achieving femoral artery puncture site hemostasis in these patients. METHODS The records of all patients undergoing Angioseal closure of femoral artery puncture by a single vascular surgeon were reviewed. Indication, type of intervention, and size of the vascular sheath employed were recorded. Times to mobilization and discharge were determined. Patients were seen before discharge and 1, 4, and 12 weeks after the procedure, and at 3- month intervals thereafter. Complications including hemorrhage, pseudoaneurysm, infection, and vessel occlusion were noted. RESULTS Between February 1, 2002, and August 31, 2003, 220 Angioseal collagen plugs were deployed in 188 patients. Attempts were made to deploy Angioseal devices in 92% of patients undergoing percutaneous procedures during this time period. One hundred forty-four procedures were diagnostic and 74 procedures included 76 therapeutic interventions. One hundred forty-four 5F sheaths, 47 6F sheaths, and 29 7F sheaths were employed during the procedures. Time to mobilization and discharge was 58 +/- 19 minutes and 102 +/- 31 minutes in patients undergoing diagnostic studies, 68 +/- 22 minutes and 146 +/- 42 minutes following interventions using 6F sheaths, and 127 +/- 18 minutes and 219 +/- 37 minutes when interventions were performed using 7F sheaths. No patient developed a major hematoma or infection following the use of an Angioseal. There were 2 complications related to device deployment. One patient developed a 1.4-cm false aneurysm at the femoral artery puncture site that resolved spontaneously. A second patient required operation for vessel occlusion when an Angioseal was deployed in a markedly diseased femoral artery. These adverse events occurred early in our experience. CONCLUSIONS The Angioseal provides a secure method of achieving hemostasis following femoral artery puncture. It is easy to deploy, has a high level of patient satisfaction, and allows for early ambulation and hospital discharge. When simple guidelines are observed, the device can be safely used in the great majority of patients with peripheral vascular disease. It offers considerable advantages over the traditional method of manual compression.
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Affiliation(s)
- Alan Abando
- Department of Surgery, Division of Vascular Surgery, University of Southern California Keck School of Medicine, Huntington Memorial Hospital, Pasadena, USA
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25
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Juergens CP, Leung DYC, Crozier JA, Wong AM, Robinson JTC, Lo S, Kachwalla H, Hopkins AP. Patient tolerance and resource utilization associated with an arterial closure versus an external compression device after percutaneous coronary intervention. Catheter Cardiovasc Interv 2004; 63:166-70. [PMID: 15390237 DOI: 10.1002/ccd.20161] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We assessed patient tolerance and resource utilization of using the AngioSeal closure device versus assisted manual compression using the Femostop device after percutaneous coronary intervention (PCI). Patients undergoing PCI with clean arterial access and no procedural hematoma were randomized to receive the AngioSeal or Femostop device to achieve femoral arterial hemostasis. Times from procedure end to removal from angiography table, hemostasis, ambulation, and hospital discharge were recorded. Bedside nursing/medical officer care time, vascular complications, and disposable use were also documented. Patient comfort was assessed using Present Pain Intensity and Visual Analogue scales at baseline, 4 hr, 8 hr, and the morning after the procedure. One hundred twenty-two patients were enrolled (62 AngioSeal, 60 Femostop). Patients in the AngioSeal group took longer to be removed from the angiography table (11 +/- 4 vs. 9 +/- 3 min; P = 0.002) compared with the Femostop group. Time to hemostasis (0.4 +/- 1.1 vs. 6.4 +/- 1.7 hr; P < 0.001) and ambulation (17 +/- 8 vs. 22 +/- 13 hr; P = 0.004) were less in the AngioSeal group, although time to discharge was not different. Nursing and medical officer time was no different. Disposables including device cost were higher in the AngioSeal group (209 dollars +/- 13 vs. 53 dollars +/- 9; P < 0.001). On a Visual Analogue scale, patients reported more pain at 4 hr (P < 0.001) and 8 hr (P < 0.001) in the Femostop group. The worst amount of pain at any time point was also more severe in the Femostop group (P < 0.001). Similar results were found on a Present Pain Intensity scale of pain. There were no differences in ultrasound-determined vascular complications (two each). Femoral access site closure using the AngioSeal device resulted in a small delay in leaving the angiography suite and a higher disposable cost compared to using the Femostop device. However, patients receiving the AngioSeal were able to ambulate sooner and reported less pain, which may justify the increased costs involved.
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Affiliation(s)
- Craig P Juergens
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia.
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Abstract
Both sealing and suturing closure devices have been shown to shorten hemostasis time, reduce the discomfort of manual or mechanical compression, and allow for earlier ambulation after cardiac catheterization and percutaneous coronary interventions without increasing vascular complications compared with conventional compression techniques. Several studies now report a reduction in vascular complications for percutaneous coronary intervention patients treated with closure devices compared with manual compression with pronounced benefit seen in patients receiving glycoprotein IIb/IIIa receptor inhibitors. Adoption of a simple predeployment femoral angiogram is now standard practice for use of a closure device. In an attempt to develop devices that are safer and more "user friendly," considerable modifications and improvements have been made in newer generation devices. Ultimately, the acceptance of femoral closure devices will depend on which device provides a simple approach with reliable hemostasis and a cost that can justify their incorporation into routine practice.
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Affiliation(s)
- Timothy A Sanborn
- Division of Cardiology, Evanston Northwestern Healthcare, Evanston, IL 60201, USA.
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Abstract
Advances in interventional angiography such as covered stent technology and adjunctive anticoagulation and antiplatelet therapy for arterial recanalization have reached the margins of percutaneous application. In these circumstances, compression methods of arterial closure require prolonged compression or long arterial sheath dwell times that increase procedural time, complication rates, and patient discomfort. Percutaneous arterial closure devices offer the potential of rapid hemostasis and shorter times to ambulation and discharge. These benefits have costs, in terms of the price of the devices and complications of their use. A Web search identified approved and pending devices. A Medline search identified device studies that were reviewed to assess the efficacy and complication rates of device-mediated closure versus the gold standard of manual compression. Studies that compared devices were evaluated to determine if any particular device was superior. The arterial closure devices were equivalent to manual compression in the establishment of hemostasis in the diagnostic population. However, complication rates were higher. In the therapeutic populations, the devices were as efficacious as manual compression, without correction of anticoagulation, and the complication rates were similar. No individual device was clearly superior.
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Affiliation(s)
- Eric K Hoffer
- Section of Vascular and Interventional Radiology, Department of Radiology, Harborview Medical Center, University of Washington, Box 359728, 325 9th Avenue, Seattle, Washington 98104, USA.
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Hofmann LV, Sood S, Liddell RP, Gupta A, Arepally A, Rodriguez ER, Eng J. Arteriographic and pathologic evaluation of two suture-mediated arterial closure devices in a porcine model. J Vasc Interv Radiol 2003; 14:755-61. [PMID: 12817043 DOI: 10.1097/01.rvi.0000079985.80153.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the acute and short-term effects the Sutura 8-F SuperStitch and Perclose 6-F Closer devices have on the femoral artery, as determined by angiography and pathologic examination. MATERIALS AND METHODS From a common carotid artery cutdown, eight pigs underwent pelvic angiography (i) before placement of bilateral common femoral artery vascular sheaths, (ii) after sheath insertion, and (iii) after device deployment. Two pigs were immediately killed; six survived 4 weeks for repeat angiography and vessel harvest. RESULTS Average vessel diameter before sheath insertion was 5.9 mm +/- 0.6 and 5.8 mm +/- 0.6 for vessels with Perclose and Sutura devices, respectively. After deployment of the Sutura device, there was a 44.7% (P =.001) mean diameter reduction from preprocedural diameters, compared to a 59.3% reduction (P <.001) with the Perclose device. After deployment of the Sutura device, there was a mean vessel diameter reduction of 14.1% (P =.53) versus the diameter immediately after sheath placement. After deployment of the Perclose device, there was a mean vessel diameter reduction of 43.8% (P =.05) versus the diameter immediately after sheath placement. At 4-week angiography, all vessels returned to their original diameters before sheath insertion. Pathologic examination showed mild adventitial fibrosis creating a "fibrous hood" surrounding the suture and vessel. CONCLUSIONS Despite significant luminal compromise after device deployment, all vessels appeared normal on angiography at 4 weeks. Contrary to the normal angiographic findings, both devices incited periadventitial fibrosis, which created a fibrous hood around the suture and vessel.
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Affiliation(s)
- Lawrence V Hofmann
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Blalock 545, 600 North Wolfe Street, Baltimore, Maryland 21287, USA.
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Rilling WS, Dicker M. Arterial puncture closure using a collagen plug, I. (Angio-Seal). Tech Vasc Interv Radiol 2003; 6:76-81. [PMID: 12903000 DOI: 10.1053/tvir.2003.36448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Closure devices can generally be categorized by their mechanism of obtaining hemostasis. Currently, devices are either suture-based, collagen-based, or utilize a combination of technologies. They can also be classified on the basis of whether or not they have an intravascular component or exclusively extra-vascular components. The devices that are currently available differ markedly in their mechanism of action, deployment, advantages, and disadvantages. In this article, we will review in detail the Angio-Seal closure device, review some of the current literature regarding this device, and assess its complications, advantages, and disadvantages.
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Affiliation(s)
- William S Rilling
- Section of Vascular/Interventional Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, WI 53226, USA
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Alonso M, Tascón J, Hernández F, Andreu J, Albarrán A, Velázquez MT. [Complications with femoral access in cardiac cathetization. Impact of previous systematic femoral angiography and hemostasis with VasoSeal-ES collagen plug]. Rev Esp Cardiol 2003; 56:569-77. [PMID: 12783732 DOI: 10.1016/s0300-8932(03)76918-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Most cardiac catheterizations are performed via femoral artery access, and hemostatic devices are commonly used. We evaluate the relationship between the strategy used for femoral arteriography and the use of VasoSeal-ES, and local vascular complications. PATIENTS AND METHOD Prospective study of 540 consecutive catheterizations with systematic femoral artery and sheath angiography. VasoSeal-ES was used in 427 patients. Predictors of local vascular complications such as patient-related factors, anatomy and hemostasis were analyzed. Variables related to failure of the collagen plug were also studied. RESULTS Punctures of the common femoral artery occurred in 35.9% of all patients (16% in the deep femoral artery and its ostium). Spasm was evident in 18% (ranging from 58.1% in the deep femoral artery to 5.2% in the common femoral artery). Puncture at the site of ramification was seen in 11.3%. Angiographically significant atheroma was seen in 17.8%. The femoral head was a valid landmark for the common femoral artery in only 63.9% of the pateints. Risk factors for local vascular complications were punctures of the common femoral artery, female sex and failure of VasoSeal-ES to achieve hemostasis (15.8% in the first two months of use, 5.2% in the last months of the study). Complications involving superficial and deep femoral arteries occurred in 6.7% and 1.2% of the patients, respectively, in contrast to 0.6% involving the common femoral artery. Variables related to collagen plug failure were patient-related factors, weight less than 55 kg, operator-related factors and the learning curve. CONCLUSIONS Systematic femoral angiography provides data that aids the choice of the best hemostasis procedure to reduce local vascular complications. Punctures of the common femoral artery were more frequent than expected, and were associated with a higher complication rate. VasoSeal-ES is a safe and useful method of hemostasis, and its infrequent failures were associated with high complication rates that were substantially reduced with experience.
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Affiliation(s)
- Manuel Alonso
- Servicio de Cardiología. Hospital Universitario 12 de Octubre. Madrid. España.
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Abstract
As of July 2000, there were 4 closure devices with Food and Drug Administration (FDA) approval. The devices are successfully deployed in 89% to 98% of cases, and the complication rates are comparable to those seen with manual compression. Minor access site complications are defined as bleeding not requiring transfusion or surgical repair, hematoma (<5 cm), and pain at the puncture site. Major complications include hematoma (>5 cm), bleeding at the site requiring transfusion, pseudoaneurysm, arteriovenous fistula, retroperitoneal hemorrhage, plug embolization, groin infection, and death.
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Ansel GM. Closure device euphoria? Catheter Cardiovasc Interv 2003; 58:292. [PMID: 12594689 DOI: 10.1002/ccd.10458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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