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Ahrari A, Healy GM, Min A, Alkhalifah F, Oreopoulos G, Teng Tan K, Jaberi A, Rajan DK, Mafeld S. Real-World Experience With the Angio-Seal Closure Device: Insights From Manufacturer and User Facility Device Experience Database. J Endovasc Ther 2023:15266028231219226. [PMID: 38110358 DOI: 10.1177/15266028231219226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE Angio-Seal (Terumo Medical Corporations, Somerset, New Jersey) device is indicated for femoral arteriotomy closure. Real-world published data on complications are limited. We present 1 year of safety events involving Angio-Seal from the US Food and Drug Administration's post-market surveillance database of Manufacturer and User Facility Device Experience (MAUDE). Steps for managing frequent device-related problems are discussed. MATERIALS AND METHODS Angio-Seal MAUDE data from November 2019 to December 2020 was classified according to (1) mode of device failure, (2) complication, (3) treatment, and (4) Cardiovascular and Interventional Radiological Society of Europe (CIRSE) adverse event classification system. RESULTS There were 715 safety events, involving Angio-Seal VIP (93.1%), Evolution (5.7%), STS Plus (1.1%), and sizes 6F (62.5%) and 8F (37.5%). Failure mode involved unrecognized use of a damaged device (43.4%), failed deployment (20.1%), failed arterial advancement (6.3%), detachment of device component (4.9%), failed retraction (3.6%), operator error (1.1%), and indeterminate (20.6%). Of total, 44.8% of events were associated with patient harm. Complications involved minor blood loss (34.1%), hematoma (5.6%), significant blood loss (1.4%), and pseudoaneurysm (1.4%). Of total, 43.3% of cases required manual compression (MC), whereas 8.8% required more advanced intervention. Interventions included surgical repair (49.2%), thrombin injection (9.5%), balloon tamponade (6.3%), covered stent (4.8%), and unspecified (30.2%). Majority of safety events were CIRSE grade 1 (92.0%), followed by grades 2 (3.1%), 3 (4.6%), and 6 (deaths, 0.3%). Minority of devices were returned for manufacturer analysis (27.8%). CONCLUSIONS The majority of safety events were associated with minor blood loss or local hematoma and could be addressed with MC alone. Most events were attributed to damaged device; however, very few devices were returned to manufacturer for analysis. This should be encouraged to allow for root cause analysis in order to improve safety profile of devices. System-level strategies for addressing barriers to under-reporting of safety events may also be considered. CLINICAL IMPACT Our study highlights important safety events encountered in real-world practice with Angio-Seal closure device. The MAUDE database captures real-world device malfunctions not typically appreciated in conventional clinical trials. Our study provides valuable insight for clinician-users on anticipating and managing the most common device malfunctions. Additionally, our data provide feedback for manufactures to optimize product design and direct manufacturer user training to improve safety. Finally, we hope that the study promotes system-level strategies that foster reporting of safety events and undertaking of root cause analysis.
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Affiliation(s)
- Aida Ahrari
- Department of Radiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Gerard M Healy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Adam Min
- Department of Radiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Fahd Alkhalifah
- Department of Radiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - George Oreopoulos
- Joint Department of Medical Imaging, University Health Network and Sinai Health System, Toronto, ON, Canada
- Division of Vascular Surgery, University Health Network, Toronto, ON, Canada
| | - Kong Teng Tan
- Department of Radiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Arash Jaberi
- Department of Radiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Dheeraj K Rajan
- Department of Radiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Sebastian Mafeld
- Department of Radiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network and Sinai Health System, Toronto, ON, Canada
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Shariq M, Premnath KPB, Saleh AT, Coker J. Complications with the use of Angio-Seal vascular closure device and their management. J Clin Imaging Sci 2023; 13:26. [PMID: 37810184 PMCID: PMC10559466 DOI: 10.25259/jcis_68_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/30/2023] [Indexed: 10/10/2023] Open
Abstract
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.
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Affiliation(s)
- Mohd Shariq
- Department of Clinical and Interventional Radiology, Queens Hospital, Romford, United Kingdom
| | | | - Ahmed Tarek Saleh
- Department of Clinical and Interventional Radiology, Queens Hospital, Romford, United Kingdom
| | - Julian Coker
- Department of Vascular Surgery, Queens Hospital, Romford, United Kingdom
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Sugawara M, Hoshina K, Chigira M, Suzuki H, Daimon M, Takayama T, Ono Y, Yatomi Y. Usefulness of duplex ultrasonography to detect collagen sponge misplacement into the arterial lumen during the use of Angio-Seal: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211004818. [PMID: 33854782 PMCID: PMC8013637 DOI: 10.1177/2050313x211004818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/16/2022] Open
Abstract
A 76-year-old man who had undergone percutaneous coronary intervention suffered intermittent claudication. Duplex ultrasonography revealed superficial femoral artery stenosis with an intraluminal heterogeneous echogenic mass. We suspected that stenosis was caused by the puncture procedure of the Angio-Seal. Open surgery revealed that a collagen sponge that should have been outside the arterial wall was misplaced in the wall with massive granulation, and atherectomy with patchplasty was performed. Vessel deterioration was considered due to several factors, including inappropriate access site, arterial wall calcification, and comorbidities like Behçet's disease. Ultrasonography is a convenient and useful method to evaluate arterial lesions.
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Affiliation(s)
- Masayo Sugawara
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Department of Vascular Surgery, The University of Tokyo, Tokyo, Japan
| | - Mayumi Chigira
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirohide Suzuki
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
| | - Masao Daimon
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Takayama
- Department of Vascular Surgery, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ono
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan
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Chatzigeorgiadis P, Hellwig K, Almasi-Sperling V, Meyer A, Lang W, Rother U. Major vascular complications after transfemoral arterial closure system implantation: a single-center study. INT ANGIOL 2020; 39:139-144. [DOI: 10.23736/s0392-9590.19.04253-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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A systematic review and meta-analysis of risk factors for and incidence of 30-day readmission after revascularization for peripheral artery disease. J Vasc Surg 2020; 70:996-1006.e7. [PMID: 31445653 DOI: 10.1016/j.jvs.2019.01.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 01/19/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Readmission to the hospital after revascularization for peripheral artery disease (PAD) is frequently reported. No consensus exists as to the exact frequency and risk factors for readmission. This review aimed to determine the incidence of and risk factors for 30-day readmission after revascularization for PAD. METHODS PubMed/Medline (Ovid), Scopus, Web of Science, the Cochrane Library, and CINAHL were searched systematically from inception until May 20, 2018. Studies were eligible for inclusion if they included patients with diagnosed PAD undergoing revascularization and reported the readmission rate and a statistical evaluation of the association of at least one risk factor with readmission. Studies were excluded if data for other procedures could not be distinguished from revascularization. Two authors undertook study selection independently with the final inclusion decision resolved through consensus. The PRISMA and Meta-analyses of Observational Studies in Epidemiology guidelines were followed regarding data extraction and quality assessment, which was performed by two authors independently. Data were pooled using a random effects model. RESULTS The primary outcome was readmission within 30 days of revascularization. Fourteen publications reporting the outcomes of 526,008 patients were included. Reported readmission rates ranged from 10.9% to 30.0% with a mean of 16.4% (95% confidence interval [CI], 15.1%-17.9%). Meta-analyses suggested the following risk factors had a significant association with readmission: female sex (odds ratio [OR], 1.13; 95% CI, 1.05-1.21), black race (OR, 1.36; 95% CI, 1.28-1.46), dependent functional status (OR, 1.72; 95% CI, 1.43-2.06), critical limb ischemia (OR, 2.12; 95% CI, 1.72-2.62), emergency admission (OR, 1.75; 95% CI, 1.43-2.15), hypertension (OR, 1.39; 95% CI, 1.26-1.54), heart failure (OR, 1.82; 95% CI, 1.50-2.20), chronic pulmonary disease (OR, 1.19; 95% CI, 1.08-1.32), diabetes (OR, 1.47; 95% CI, 1.32-1.63), chronic kidney disease (OR, 1.93; 95% CI, 1.62-2.31), dialysis dependence (OR, 2.08; 95% CI, 1.75-2.48), smoking (OR, 0.83; 95% CI, 0.78-0.89), postoperative bleeding (OR, 1.70; 95% CI, 1.23-2.35), and postoperative sepsis (OR, 4.13; 95% CI, 2.02-8.47). CONCLUSIONS Approximately one in six patients undergoing revascularization for PAD are readmitted within 30 days of their procedure. This review identified multiple risk factors predisposing to readmission, which could potentially serve as a way to target interventions to reduce readmissions.
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Dong H, Peng M, Jiang X, Che W, Zou Y, Xu B, Yang Y, Gao R. Endovascular therapy for Angio-seal TM -related acute limb ischemia: Perioperative and long-term results. Catheter Cardiovasc Interv 2017; 89:609-615. [PMID: 28191744 DOI: 10.1002/ccd.26936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the perioperative and long-term outcomes of endovascular therapy for Angio-sealTM -related acute limb ischemia. BACKGROUND Currently, limited data are available on the optimal treatment strategy for Angio-sealTM -related acute lower limb ischemia. METHODS The prospectively maintained patient database of our institution was retrospectively searched to identify all patients who developed acute lower limb ischemia after use of the Angio-SealTM and received endovascular treatment from January 2010 to February 2016. The clinical and follow-up data were evaluated. RESULTS Thirty-two patients with Angio-SealTM -related acute limb ischemia underwent endovascular therapy, resulting in an approximated incidence of 0.29% of all implanted devices. The overall procedural success rate was 96.9%. With regard to the patients who underwent successful endovascular treatment, the culprit lesion was located in the common femoral artery in 22 (71.0%) cases, the femoral artery bifurcation in 3 (9.7%) cases and the superficial femoral artery in 6 (19.4%) cases. Ten (31.3%) patients had thrombosis in other distal lower limb arteries ipsilateral to Angio-sealTM use. Eighteen (58.1%) patients underwent balloon angioplasty alone, while nine (29.0%) patients underwent balloon angioplasty and thrombolysis, and four (12.9%) patients underwent stent implantation. One patient suffered from minor bleeding at the site of application of the Angio-sealTM . During an average of 43.5 ± 22.9 months of follow-up, three patients with symptomatic restenosis underwent a second successful balloon angioplasty and remained asymptomatic until the last follow-up. CONCLUSIONS Balloon angioplasty with selective thrombolysis or stent placement was safe and effective, with a low incidence of complication and restenosis. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Hui Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Peng
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiongjing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wuqiang Che
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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D'Ovidio C, Sablone S, Carnevale A. Death Due to an Unusual Angio-Seal-Related Complication: Case Report and Literature Review. J Forensic Sci 2016; 61:1364-8. [PMID: 27166882 DOI: 10.1111/1556-4029.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 11/28/2022]
Abstract
Angio-SealTM is a vascular closure device (VCD) that can be applied to the femoral artery following cardiac catheterization to achieve hemostasis. Although it has been demonstrated to be superior to conventional manual pressure and to reduce time to hemostasis and patient ambulation, the use of this VCD is not without its complications. In this report, we describe the case of a 55-year-old man who died due to an extremely rare event that occurred several hours after the deployment of an Angio-SealTM VCD: acute complete transverse laceration of the femoral artery that occurred because of the particular fragility of the vessel due to an unrecognized and asymptomatic arteriosclerotic disease. Few data are available in the literature about the incidence of such events, and much more remains to be done to determine how to prevent and manage its occurrence.
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Affiliation(s)
- Cristian D'Ovidio
- Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Via dei Vestini, 31, Chieti, 66100, Italy.
| | - Sara Sablone
- Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Via dei Vestini, 31, Chieti, 66100, Italy
| | - Aldo Carnevale
- Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Via dei Vestini, 31, Chieti, 66100, Italy
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Grandhi R, Zwagerman NT, Zhang X, Chen SH, Jadhav AP, Jovin T, Jankowitz BT. Initial experience with the AXERA 2 Femoral Access System in neurovascular procedures. Interv Neuroradiol 2015; 21:412-7. [PMID: 26015530 DOI: 10.1177/1591019915582163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Conventional cerebral angiography is a commonly performed procedure in medicine. Vascular closure devices have been developed as alternatives to manual compression at the arteriotomy site and prolonged bed rest. The risks of using these devices include arterial dissection, groin hematoma, and device failure. Herein, we describe our experience with the use of a novel device used for arterial access and closure, the AXERA 2 Access System. METHODS A total of 13 patients underwent vascular access and closure with the AXERA 2 Access System. RESULTS Arterial access using the AXERA 2 Access System was achieved in 11 of 13 patients. Amongst the patients with successful access, one patient experienced a groin hematoma requiring manual compression and two patients suffered occlusions of the common femoral artery due to dissections, with both patients requiring femoral artery thromboendarterectomies. CONCLUSIONS This small series highlights a heretofore underreported serious complication rate of the AXERA 2 Access System. Additional studies are warranted to provide further insight into risk factors for device failure and complication development.
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Affiliation(s)
- Ramesh Grandhi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nathan T Zwagerman
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Xiaoran Zhang
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stephanie H Chen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashutosh P Jadhav
- UPMC Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tudor Jovin
- UPMC Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brian T Jankowitz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Grandhi R, Zhang X, Panczykowski D, Choi P, Hunnicutt CT, Jadhav AP, Ducruet AF, Jovin T, Jankowitz B. Incidence of delayed angiographic femoral artery complications using the EXOSEAL vascular closure device. Interv Neuroradiol 2015; 21:401-6. [PMID: 26015532 DOI: 10.1177/1591019915581776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Femoral artery injuries are known complications of percutaneous vascular closure devices (VCDs). We studied the incidence of delayed femoral artery angiographic irregularities after neurointerventional procedures in which the EXOSEAL extravascular closure device was used for femoral arterial puncture closure. METHODS Adult patients who underwent femoral arterial puncture closures with an EXOSEAL VCD and had a follow-up femoral artery angiogram from June 2012 through August 2013 were reviewed. A blinded radiologist compared pre-deployment and follow-up femoral arteriograms for the presence of femoral artery stenosis, dissection, pseudoaneurysm, or development of an arteriovenous fistula. Hospital records were reviewed for major or minor complications of the groin site or femoral artery. RESULTS The EXOSEAL VCD achieved hemostasis, without evidence of a groin hematoma or requiring subsequent prolonged manual compression, in 400 of 441 closures following transfemoral arterial access, representing a device success rate of 90.7%. A total of 98 patients underwent 102 repeat angiograms following closure with the EXOSEAL VCD. The average time to the repeat angiogram was 73.5 days (range 0-488, median 28). Follow-up femoral arteriography demonstrated an irregularity in seven cases, all of which were vessel stenoses of <50%. There were no dissections, pseudoaneurysms, infections, or ischemic events in the study population. CONCLUSIONS Angiographic irregularities were seen in 6.86% of cases after closure with the EXOSEAL VCD. There were no clinically significant vascular complications. Thus, femoral artery closure with EXOSEAL carries a low risk of clinically significant delayed angiographic findings.
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Affiliation(s)
- Ramesh Grandhi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Xiaoran Zhang
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Panczykowski
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Phillip Choi
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Ashutosh P Jadhav
- UPMC Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew F Ducruet
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tudor Jovin
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA UPMC Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brian Jankowitz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Krishna RK, Kherada N, Beohar N. Late onset iatrogenic limb ischaemia after deployment of an Angio-Seal vascular closure device. BMJ Case Rep 2015; 2015:bcr-2015-209393. [PMID: 25917071 DOI: 10.1136/bcr-2015-209393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is common practice to deploy a vascular closure device for access site closure after percutaneous angiography or cardiovascular interventions for immediate haemostasis and to facilitate early discharge. We encountered two octogenarian women who underwent and had subsequent vascular access site closure with Angio-Seal (St Jude) and who later presented with limb ischaemia needing surgical revascularisation. Our patients had undergone uneventful deployment of the Angio-Seal vascular closure device (VCD) at the right common femoral artery (CFA) access site with successful haemostasis. About 3 weeks later they presented with features of limb ischaemia needing further diagnostic work-up including repeat angiography, which revealed subtotal occlusion of right common femoral artery at the level of prior access and Angio-Seal deployment site. Both the patients underwent successful surgical repair with restoration of distal flow and resolution of symptoms. These cases illustrate the late presentation of VCD-related complications with limb ischaemia, needing surgical revascularisation.
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Affiliation(s)
- Rama K Krishna
- Department of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Nisharahmed Kherada
- Department of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Nirat Beohar
- Department of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
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Holm NR, Sindberg B, Schou M, Maeng M, Kaltoft A, Bøttcher M, Krusell LR, Hjort J, Thuesen L, Terkelsen CJ, Christiansen EH, Bøtker HE, Kristensen SD, Lassen JF. Randomised comparison of manual compression and FemoSealª vascular closure device for closure after femoral artery access coronary angiography: the CLOSure dEvices Used in everyday Practice (CLOSE-UP) study. EUROINTERVENTION 2014; 10:183-90. [DOI: 10.4244/eijv10i2a31] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Chu G, Yang W, Zhang G, Zhang Z, Liu S, Sun B, Wang F. Safety and efficacy of the StarClose vascular closure system following 8-Fr sheath placement for intra-aortic balloon pump: a single-center analysis of 42 consecutive patients. Med Princ Pract 2014; 23:313-7. [PMID: 24776529 PMCID: PMC5586891 DOI: 10.1159/000362127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/10/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the safety and efficacy of the StarClose device following intra-aortic balloon pump (IABP) counterpulsation using 8-Fr femoral sheaths. SUBJECTS AND METHODS From June 2008 to August 2012, 42 consecutive patients who received IABP implantation via common femoral artery (CFA) punctures with an 8-Fr sheath (which were then sealed with the StarClose Vascular Closure System at the bedside) were included in this retrospective single-arm study. All the patients underwent duplex control of the puncture site 24 h after deployment of the device, in order to determine the presence or absence of vascular complications including hematoma, pseudoaneurysm, arteriovenous fistula and arterial/venous thrombosis or stenosis. The safety end points were the vascular complications during the hospital stay, and the efficacy end points included device and procedure success. RESULTS The procedure success rate was 92.9% (39/42) and the device success rate was 88.1% (37/42). Major vascular complications occurred in 3 (7.1%) patients; 1 developed a massive hematoma >10 cm which was managed by blood transfusion and surgical reconstruction, and the other 2 developed pseudoaneurysm which was cured by ultrasound-guided thrombin injection or manual compression. Minor vascular complications occurred in 5 (11.9%) patients, including blood oozing in 2, hematoma <5 cm in 2 and severe pain in the remaining patient. CONCLUSION CFA closure with the StarClose device was safe, feasible and effective in patients undergoing IABP support using 8-Fr sheath sizes.
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Affiliation(s)
| | - Wenyi Yang
- *Wenyi Yang, MD, or Fang Wang, PhD, MD, Department of Cardiology, Shanghai Jiaotong University, First People's Hospital, 85 Wu Jin Road, Shanghai 200080 (PR China), E-Mail
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13
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Hong D, Lee SH, Chung HH, Seo BK, Cha SH, Lee KY, Ahn JC. Fluoroscopic guided fogarty embolectomy for an angio-seal embolism in the popliteal artery. Korean J Radiol 2013; 14:636-9. [PMID: 23901321 PMCID: PMC3725358 DOI: 10.3348/kjr.2013.14.4.636] [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: 04/24/2012] [Accepted: 08/02/2012] [Indexed: 11/29/2022] Open
Abstract
The Angio-Seal is a widely used arterial closure device that helps achieve faster hemostasis and provide early ambulation to patients. However, it can cause various complications in clinical practice. We present the uncommon complication of popliteal artery occlusion following Angio-Seal deployment, and describe an effective interventional approach to its treatment. Because fluoroscopy-guided Fogarty embolectomy has the advantages of complete removal of the embolus without fragmentation, and clear visualization of the exact location of the embolus during the procedure, it is a suitable method for treating this complication.
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Affiliation(s)
- Doran Hong
- Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan 425-707, Korea
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14
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Maxien D, Behrends B, Eberhardt KM, Saam T, Thieme SF, Reiser MF, Treitl M. Evaluation of the 6-F ExoSeal vascular closure device in antegrade femoral artery punctures. J Endovasc Ther 2013; 19:836-43. [PMID: 23210885 DOI: 10.1583/jevt-12-3922r.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the safety, comfort, and efficacy of an extravascularly deployed bioabsorbable plug-based vascular closure device (VCD) for sealing 6-F antegrade access sites in patients requiring peripheral endovascular intervention. METHODS A single-center, single-arm, prospective study to evaluate the 6-F ExoSeal VCD in terms of technical success, adverse events, and patient comfort enrolled 59 unselected symptomatic patients (42 men; mean age 72.1 ± 9.3 years) suffering from peripheral artery disease in an 11-month period. Patients with high body mass index (BMI) or calcification at the access site were not excluded. Calcifications of the access vessel were scored as grades 1-4 from fluoroscopic images. The pain level during implantation was evaluated after the procedure using a visual rating scale. RESULTS Technical success rate was 98.3%; 1 primary device failure was converted to manual compression. In addition, 1 (1.7%) pseudoaneurysm, 2 (3.4%) minor hematomas, and 1 (1.7%) minor secondary bleeding were observed. There was no intravascular application of the device detected. Neither BMI, calcification of the access vessel (present in 74.6%, mean score 1.4 ± 1.1), age, nor blood clotting had any statistically significant influence on adverse events. In total, 55 (93.2%) patients felt no pain during the VCD implantation. CONCLUSION The tested VCD was safe, with an excellent technical success rate even in cases with severe access vessel calcification.
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Affiliation(s)
- Daniel Maxien
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Germany.
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Deitch SG, Gupta R. Radioembolization complicated by dissection of the common femoral artery. Semin Intervent Radiol 2012; 28:133-6. [PMID: 22654248 DOI: 10.1055/s-0031-1280650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The common femoral artery is the most frequently used access site for angiographic procedures in interventional radiology. Potential complications of common femoral arteriotomy include hematoma formation, pseudoaneurysm, uncontrolled groin or retroperitoneal bleeding, acute arterial occlusion, dissection, and arteriovenous fistula formation. In a case such as the one described here, with a common femoral artery dissection with intraluminal thrombus and vessel occlusion, the complication may have occurred at the time of access or at the time of closure, with both procedure-associated and patient-specific risk factors affecting the overall risk of complications. Though some studies have shown an increased risk of complications with the use of arterial closure devices, others have found no increase. In any patient with symptoms following a femoral arteriotomy, rapid diagnosis and treatment is necessary to avoid further complications. Both patient-specific and procedure-associated risk factors should be considered prior to arteriotomy and usage of an arterial closure device.
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Affiliation(s)
- Sarah G Deitch
- Department of Radiology, Northwestern University, Chicago, Illinois
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Savolainen H, Baumgartner I, Schmidli J, Heller G, Do DD, Willenberg T. Femoral pseudoaneurysms requiring surgical treatment. Trauma Mon 2012; 16:194-7. [PMID: 24749101 PMCID: PMC3989573 DOI: 10.5812/kowsar.22517464.3186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 10/30/2011] [Accepted: 11/25/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than 6.000 angiographies and/or interventions annually. OBJECTIVES The aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair. PATIENTS AND METHODS In this retrospective study, 122 (0.06%) FPAs treated among 21060 patients over a period of five years were assessed. Patient characteristics and therapeutic procedures were analyzed through hospital records. RESULTS There were 15.163 (72%) coronary and 5.897 (27%) peripheral interventions, respectively. In 89 (73%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (28%) patients underwent open surgical repair. Indication for operative treatment was hemodynamic instability in 9 (7%) patients, rapidly expanding haematoma unsuitable for USGC or after unsuccessful USGC in 23 (19%). One (0.8%) patient had an arterio-venous fistula. Intraoperative findings suggest that atypical endovascular access (e.g. deep femoral artery, lateral or medial puncture) and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in 22 (67%) cases. Most patients had active antithrombotic therapy. Gender or the nature of procedure (diagnostic vs. intervention) did not increase risk for open repair. One (0.8%) patient died. No amputations were performed. Mean hospital stay of patients undergoing open surgical repair was 11 (range 4-36) days. CONCLUSIONS Technical puncture problems were identified in 2/3 of patients requiring open surgery.
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Affiliation(s)
- Hannu Savolainen
- Academic Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Iris Baumgartner
- Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland
| | - Juerg Schmidli
- Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland
| | - George Heller
- Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland
| | - Do-Dai Do
- Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland
| | - Torsten Willenberg
- Swiss Cardiovascular Center, University Hospital, 3010 Berne, Switzerland
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Klocker J, Gratl A, Chemelli A, Moes N, Goebel G, Pachinger O, Jaschke W, Fraedrich G. Incidence and treatment of local stenosis or occlusion at the vascular access site leading to limb ischemia and new-onset intermittent claudication after percutaneous interventions: Implications of Vascular Closure Devices. Catheter Cardiovasc Interv 2011; 79:938-43. [DOI: 10.1002/ccd.23151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/19/2011] [Indexed: 01/02/2023]
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Influence of Use of a Vascular Closure Device on Incidence and Surgical Management of Access Site Complications after Percutaneous Interventions. Eur J Vasc Endovasc Surg 2011; 42:230-5. [DOI: 10.1016/j.ejvs.2011.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/14/2011] [Indexed: 11/18/2022]
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Comments regarding 'Influence of use of a vascular closure device on incidence and surgical management of access sites. Complications after percutaneous interventions'. Eur J Vasc Endovasc Surg 2011; 42:236-7. [PMID: 21592825 DOI: 10.1016/j.ejvs.2011.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 04/18/2011] [Indexed: 11/21/2022]
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Abstract
PURPOSE Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. METHODS The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. RESULTS Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0-14.5] for antegrade access and 1.8% (95% CI 1.1-2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only <0.5% of patients. Postdeployment bleeding occurred in 6.4%, and most these (51.5%) could be managed with light manual compression. During follow-up, other device-related complications were reported in 1.3%: seven false aneurysms, three hematoma >5.9 cm, and two vessel occlusions. CONCLUSION The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters.
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Thalhammer C, Joerg GR, Roffi M, Husmann M, Pfammatter T, Amann-Vesti BR. Endovascular treatment of Angio-Seal-related limb ischemia--primary results and long-term follow-up. Catheter Cardiovasc Interv 2010; 75:823-7. [PMID: 20146317 DOI: 10.1002/ccd.22407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate primary success rates and long term follow-up of endovascular treatment of AngioSeal-related limb ischemia. BACKGROUND Current knowledge on optimal therapy of ischemic complications following application of AngioSeal is limited. METHODS A single-center prospectively maintained database was retrospectively interrogated and AngioSeal-related complications requiring endovascular treatment over an 8-year-time period was identified. RESULTS Fifteen patients fulfilling the inclusion criteria were identified, resulting in an approximated incidence of 0.26% of all devices implanted at our institution. In all cases, the complication was managed successfully in the absence of complications. Eleven patients were treated with balloon angioplasty (PTA) and four with stent implantation because of suboptimal PTA results. Twelve patients were available for noninvasive vascular follow-up examination for a median time of 40 months postinterventionally. Only two patients needed a second intervention consisting of balloon angioplasty due to symptomatic restenosis. At final follow-up all patients were asymptomatic with no relevant restenosis. CONCLUSION Endovascular treatment for AngioSeal-related limb ischemia with or without stent implantation results in an excellent immediate and long-term clinical and hemodynamic outcome.
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Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. J Vasc Interv Radiol 2010; 21:470-6. [PMID: 20171903 DOI: 10.1016/j.jvir.2009.12.392] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 11/23/2009] [Accepted: 12/23/2009] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To retrospectively review a 9-year experience with endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. MATERIALS AND METHODS From June 2000 through July 2009 (109 months), 13 patients underwent endovascular management of inadvertent subclavian artery catheterization. All catheters were still in situ, including one 7-F catheter, six 8-F catheters, and six large-bore 10-11-F catheters. Treatment was performed with an Angio-Seal device (n = 6) or balloon catheters (n = 7) and by additional stent-graft placement (n = 4). RESULTS Mean follow-up was 27.3 months (range, 0.4-78 months). The 30-day mortality rate was 7.7% and the late mortality rate was 46.1%. Primary technical success was achieved in nine patients (69.2%), in four with the use of a compliant balloon catheter and in the other five with an Angio-Seal device. Complications required additional stent-graft placement in four patients (30.8%), one because of stenosis after Angio-Seal device deployment and three as a result of insufficient closure of the puncture site by balloon tamponade. Stent-graft repair was successful in all four patients, for a primary assisted technical success rate of 100%. CONCLUSIONS Endovascular techniques offer a less invasive alternative to surgery. The present limited experience shows that the use of the Angio-Seal device is not without risks, whereas balloon tamponade is not always reliable in closing the puncture site. Stent-graft placement may be required in patients in whom balloon tamponade fails or in whom the use of the Angio-Seal device is contraindicated.
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Ease of using a dedicated percutaneous closure device after inadvertent cannulation of the subclavian artery: case report. Case Rep Med 2009; 2009:728629. [PMID: 19718242 PMCID: PMC2729251 DOI: 10.1155/2009/728629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 05/24/2009] [Indexed: 11/27/2022] Open
Abstract
Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical). This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively.
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Branzan D, Sixt S, Rastan A, Schwarz T, Schwarzwälder U, Bürgelin K, Noory E, Beyersdorf F, Zeller T. Safety and Efficacy of the StarClose Vascular Closure System Using 7-F and 8-F Sheath Sizes:A Consecutive Single-Center Analysis. J Endovasc Ther 2009; 16:475-82. [PMID: 19702352 DOI: 10.1583/09-2761r.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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