Preventing vascular access site complications during interventional procedures

Transaxillary endovascular aortic aneurysm repair using a reverse mounted Gore Excluder endograft for a patient with abdominal aortic aneurysm and severe iliofemoral occlusive disease

Adverse iliofemoral anatomy represents a unique challenge for endovascular aortic aneurysm repair (EVAR). This report describes a transaxillary EVAR in a patient with severe iliofemoral occlusive disease and an infrarenal aortic aneurysm. A reversely mounted Gore Excluder graft was advanced and deployed in the infrarenal aorta using the left axillary artery. Lithoangioplasty and stenting were performed on bilateral iliofemoral anatomy. At the 1-year follow-up, the aneurysm sac revealed regression without endoleaks and the iliofemoral stents remained patent. The transaxillary approach may be a feasible access site for EVAR in patients with a high risk for open repair and prohibitive iliofemoral anatomy.

Analysis of predictive and preventive factors for access complications associated with vascular closure devices in complicated endovascular procedures

PURPOSE

The main goal is to evaluate the effectiveness of angioseal and starclose vascular closure devices (VCDs) in high-risk patients under intensive anticoagulation who require therapeutic angiographic procedures and to discuss which factors are important in complications associated with VCDs.

MATERIALS AND METHODS

Medical records of the patients who underwent therapeutic complex interventional vascular procedures were reviewed retrospectively. One hundred sixty-six patients were divided into two groups regarding VCDs used for access-site closure after the procedure: group 1, (angioseal); group 2, (starclose). Data including patients' demographics and comorbidity information, procedural characteristics, and complications were analyzed.

RESULTS

The device deployment success rate was 100%. For the procedural characteristics, there was no significant difference between the groups except access site (P = 0.016) and sheath size > 6F (P = 0.0001). No major complications had occurred in none of the patients. Minor complications including hematoma, access-site pain, and access-site infection, except prolonged hemostasis did not differ significantly between groups. The patients' demographic and periprocedural factors were not significantly correlated with the development of complications.

CONCLUSION

Contrary to published reports, our study showed that demographic and periprocedural factors may not be responsible for the vascular access-site complications associated with VCDs.