Angio-Seal™ Embolization: A Rare Etiology of an Acute Distal Limb Ischemia

Complications with the use of Angio-Seal vascular closure device and their management

Vascular closure devices (VCDs) are being increasingly used for achieving hemostasis after diagnostic and therapeutic endovascular procedures. Although uncommon, complications may be encountered which are associated with the use of these VCDs. We report four cases where the use of Angio-Seal (Terumo, Somerset, New Jersey, USA) was followed by complications. Three cases presented with acute limb ischemia, among them, two patients had arterial occlusion at the vascular access site and one patient had embolization of the footplate anchor of the closure device. One case presented with pseudoaneurysm at the common femoral artery access site along with occlusion at origin of the superficial femoral artery. We have described the mechanism in which these complications occur and the successful management of these cases preventing potential amputation and limb loss. The risk factors which increase the risk of complications with the use of Angio-Seal VCD were reviewed and the strategy to avoid these complications with particular emphasis on the utility of ultrasound when using Angio-Seal VCD is discussed. A strategy to manage these complications has been discussed while deciding on endovascular management or surgical management, especially in patients with challenging presentation and those with multiple comorbidities making them at very high risk for surgery.

Treatment of Common Femoral Artery Pseudoaneurysm: A Novel Approach Utilizing a VASCADE Percutaneous Closure Device

Iatrogenic common femoral artery pseudoaneurysm is a well-known complication to vascular access. Many options, both surgical and nonsurgical, have been implemented as means to treat pseudoaneurysms such as thrombin injection, image-guided compression, and percutaneous closure devices. This case report demonstrates a novel technique using a VASCADE closure device to successfully treat an iatrogenic common femoral pseudoaneurysm.