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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gouëffic Y, McWilliams RG, Burton HE, Verin N. Costs and budget impact of collagen-based vascular closure device versus manual compression following peripheral endovascular procedures. Ann Vasc Surg 2023:S0890-5096(23)00097-3. [PMID: 36870564 DOI: 10.1016/j.avsg.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To evaluate the annual costs and budget impact of using a vascular closure device to achieve haemostasis following femoral access endovascular procedures in England, compared with manual compression. METHODS A budget impact model was developed in Microsoft® Excel, based on the estimated number of peripheral endovascular procedures eligible for day-case management performed annually by the National Health Service in England. The clinical effectiveness of vascular closure devices was captured based on the requirement for inpatient stays and the incidence of complications. Data for endovascular procedures, time to haemostasis, length of hospital stay, and complications were collected from public sources and the published literature. There were no patients involved in this study. Model outcomes are reported as estimated number of bed days and annual costs to the National Health Service for all peripheral endovascular procedures in England, and the average cost per procedure. The robustness of the model was tested in a sensitivity analysis. RESULTS The model estimated savings for the National Health Service of up to £4.5 million annually if vascular closure devices were used in every procedure instead of manual compression. The model estimated an average cost saving of £176 per procedure for vascular closure devices over manual compression, primarily due to fewer inpatient stays. The sensitivity analysis demonstrated that the proportion of day-case procedures for vascular closure devices and manual compression was a key driver of costs and savings. CONCLUSIONS The use of vascular closure devices for achieving haemostasis after peripheral endovascular procedures may be associated with lower resource use and cost burden, compared with manual compression, based on shorter time to haemostasis and ambulation and an increased likelihood of a day-case procedure.
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Affiliation(s)
- Y Gouëffic
- Department of Vascular and Endovascular Surgery, Groupement hospitalier Paris St Joseph, Paris, France.
| | - R G McWilliams
- Vascular & Interventional Radiology, Royal Liverpool University Hospital, Liverpool, UK
| | - H E Burton
- DRG Abacus, part of Clarivate, London, UK
| | - N Verin
- Terumo Europe N.V, Leuven, Belgium
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Auer TA, Fehrenbach U, Torsello GF, Collettini F, Wieners G, Günther RW, Gebauer B. Transaneurysmal Occlusion of Complicated Common Femoral Artery Pseudoaneurysms Using the Angio-Seal Closure Device-A Promising Technique. Cardiovasc Intervent Radiol 2023; 46:268-73. [PMID: 36526800 DOI: 10.1007/s00270-022-03332-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Pseudoaneurysm (PSA) developing after catheter examinations is one of the most frequent vascular complications and a nonsurgical technique with utmost low risk of complications is warranted. Our aim was to investigate the technical feasibility, success, and safety of transaneurysmal occlusion of complicated post-interventional common femoral artery (CFA) PSA using the Angio-Seal Closure Device (ASCD) and a technique that we describe as the transaneurysmal (TA) maneuver. MATERIAL AND METHODS We used the Angio-Seal (Terumo, Tokyo, Japan) Closure System to manage complicated PSAs in patients who would otherwise have needed surgery after failure of all conservative therapies. The TA maneuver was performed in 14 consecutive patients from July 2021 to July 2022. After ultrasound-guided puncture of the PSA close to its neck, the CFA was entered radiographically with micro-guidewires, and the neck of the PSA was closed with the ASCD after changing the sheaths and wires. All patient had to wear a pressure dressing until the next day, when successful closure was verified by sonography. RESULTS All procedures were performed with technical success and without any complications. No patient had to undergo surgery. All sonographies on the next day confirmed complete absence of perfusion within the PSA and normal flow conditions of the CFA and vessels below. CONCLUSION The TA maneuver a promising minimally invasive procedure for closing complicated PSA of the CFA after catheter examination.
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Loh EJ, Allen R. Endovascular treatment of refractory iatrogenic femoral artery pseudoaneurysm using Amplatzer vascular plugs following unsuccessful retrograde Angio-Seal deployment. Indian J Radiol Imaging 2021; 29:211-214. [PMID: 31367094 PMCID: PMC6639869 DOI: 10.4103/ijri.ijri_332_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Iatrogenic common femoral artery pseudoaneurysm is a well-known vascular access complication of angiography and transfemoral intervention. Thrombin injection is a well-accepted technique in treating these pseudoaneurysms but possess a significant risk of distal lower extremity thrombosis leading to severe consequences. Several case reports described the novel approach to closing these pseudoaneurysms via a retrograde deployment of an Angio-Seal vascular closure device. We describe a case of a successful treatment of refractory iatrogenic femoral artery pseudoaneurysm using Amplatzer vascular plugs following unsuccessful retrograde deployment of an Angio-Seal vascular closure device.
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Affiliation(s)
- Eu Jhin Loh
- Department of General Surgery, Calvary Mater Hospital, Waratah, NSW, Australia
| | - Robert Allen
- Department of Medical Imaging, The Canberra Hospital, Garran, ACT, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Arunothayaraj S, Palmer S, Whitbourn R. The Art of the Seal. JACC Cardiovasc Interv 2021; 14:e117-e118. [PMID: 33744211 DOI: 10.1016/j.jcin.2020.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Sandeep Arunothayaraj
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
| | - Sonny Palmer
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Robert Whitbourn
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Essibayi MA, Cloft H, Savastano LE, Brinjikji W. Safety and efficacy of Angio-Seal device for transfemoral neuroendovascular procedures: A systematic review and meta-analysis. Interv Neuroradiol 2021; 27:703-711. [PMID: 33601976 DOI: 10.1177/1591019921996100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Angio-Seal is a commonly used device for femoral hemostasis in neuroendovascular procedures. This meta-analysis investigates of the safety and efficacy of Angio-Seal in patients undergoing endovascular neurointerventional procedures. METHODS A systematic review and meta-analysis on all studies evaluating the Angio-Seal device in neurointerventional procedures from inception through 2020 were performed. We studied rates of groin hematoma, retroperitoneal hematoma, pseudoaneurysm, ipsilateral DVT, and ischemic complications. Meta-analysis was performed using the random-effects model. RESULTS 13 studies were included in our analysis. 2250 patients with 104 complications were found {4.5% (95% CI, 2.7%-6.3%)}. Of these complications, groin hematoma was the most common with a rate of 2.4% (95% CI, 1.1%-3.6%). Retroperitoneal hematoma {0.3% (95% CI, 0%-0.5%)}, pseudo-aneurysm {0.5% (95% CI, 0.2%-0.8%), and ipsilateral DVT {0.3% (95% CI, 0.1%-0.7%) were also not in negligible rate. The rate of other complications were as follows: vessel occlusion/stenosis; 0.2% (95% CI, 0%-0.4%), vascular surgery; 0.2% (95% CI, 0%-0.5%), and infection; 0.2% (95% CI, 0%-0.5%). One patient died as result of hemorrhagic complications {0.1% (95% CI, 0%-0.3%)}. Use of anticoagulant/antiplatelet therapy was found to be positively correlated with high risk of any groin complication and groin hematoma (p ≤ .05). Female gender was associated with high risk of ipsilateral DVT (p ≤ .05). Interestingly, large sheath size was associated with low risk of groin hematoma (p ≤ .05). CONCLUSION The safety and efficacy rate of Angio-Seal was approximately 95%. The most common complication was groin hematoma. Serious complications including retroperitoneal hematoma and femoral artery occlusion were rare.
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Affiliation(s)
| | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Yokoyama T, Hamasuna R, Ohta H, Takeshima H. Risk Factors for Puncture Site Complications Using the Angio-Seal Closure Device in Endovascular Therapy: A Single-center Analysis. J Neuroendovasc Ther 2020; 14:48-55. [PMID: 37502456 PMCID: PMC10370798 DOI: 10.5797/jnet.oa.2019-0060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/24/2019] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To retrospectively analyze the complication rates and risk factors associated with the use of the Angio-Seal vascular closure device during neuroendovascular therapy. METHODS In this study, we enrolled 283 patients who underwent Angio-Seal hemostasis between December 2005 and June 2019 at our institute. We retrospectively analyzed the major and minor complication rates and risk factors between the complication and no-complication groups using the medical charts of patients for whom the device was used. RESULTS Of the 283 patients, 5 had major complications (1.8%) and 18 had minor complications (6.3%). There were no significant differences between the complication (n = 23) and no-complication (n = 260) groups regarding the baseline characteristics or operation procedures. Among the major complications, superficial femoral artery puncture, 8Fr device, Angio-Seal Evolution, post-carotid artery stenting, dual antiplatelet therapy, and delirium were considered risk factors. CONCLUSION The Angio-Seal is a safe and useful hemostatic device. However, puncture site complications need to be considered when the device is used for contraindicated patients or for those with delirium who cannot rest following the procedure.
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Affiliation(s)
- Takahiro Yokoyama
- Department of Neurosurgery, Saito-Koyu Medical Center, Saito, Miyazaki, Japan
| | - Ryoichi Hamasuna
- Department of Neurosurgery, Saito-Koyu Medical Center, Saito, Miyazaki, Japan
| | - Hajime Ohta
- Department of Neurosurgery, Division of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, Division of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
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Smith JC, Monroe EJ, Shivaram GM, Shaw DWW, Koo KSH. An update on the use of an arterial closure device following femoral arterial puncture in children. Pediatr Radiol 2019; 49:1217-21. [PMID: 31190109 DOI: 10.1007/s00247-019-04442-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of arterial closure devices in achieving femoral hemostasis has been well documented in adults but insufficiently studied in the pediatric population. An earlier study from our institution of 40 Angio-Seal devices in 38 patients concluded that the arterial closure device is safe in children with only a single minor complication. Ongoing experience with this device at our institution, however, suggests a higher rate of complication. OBJECTIVE To retrospectively evaluate the safety and efficacy of the Angio-Seal in a pediatric population. MATERIALS AND METHODS A retrospective analysis reviewed all cases in which the Angio-Seal was deployed from June 2011 to September 2017. Peri-procedural documentation was reviewed for pre-procedure labs, clinical effectiveness in achieving hemostasis and complications related to the use of this device. Logistic regression analysis was also used to evaluate the relationship between patient demographic, vessel size and indication for angiography, and the presence or absence of complications. RESULTS During the study period, 48 additional Angio-Seal devices were deployed in 41 consecutive patients. Five patients were excluded for being older than 18 years. The mean age of the patients was 13.3 years (range: 4-18 years) with 18 patients female. The mean common femoral artery diameter was 5.98 mm in short axis diameter (range: 4-9 mm). Complications were present in 6/43 cases (14%) including 3 minor and 3 major complications that included additional procedures. No significant relationship was identified between vessel size, age and the indication for angiography, and the rate of complication on logistic regression analysis. CONCLUSION While percutaneous arterial closure devices can be efficacious for achieving hemostasis, our experience demonstrates a higher rate of complications in children, contrary to a previous report. The deployment of such devices should be performed with prejudice in this population.
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Hall TC, Habib S. A Novel Intervention to Treat Failed Angio-Seal Footplate Deployment: Two Case Series. Clin Med Insights Case Rep 2019; 12:1179547619828714. [PMID: 30792582 PMCID: PMC6376524 DOI: 10.1177/1179547619828714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022]
Abstract
Introduction Vascular closure devices are commonly used to achieve rapid haemostasis and early ambulation following arterial puncture for endovascular procedures. Although device failure rates are low, the consequences of arterial occlusion include severe limb ischaemia. We describe a novel endovascular technique for the treatment of Angio-Seal arterial closure device (Terumo, Europe NV) failure causing femoral artery occlusion. Materials and methods We describe 2 cases of lower limb angioplasty performed for critical limb ischaemia where the access site was closed using an Angio-Seal according to the manufacturer instructions for use (IFU). In both cases, however, ultrasound could not be used during deployment of the Angio-Seal due to body habitus and small subcutaneous haematoma. In both cases, the device failed and occluded the femoral artery. Results Access was achieved via a retrograde approach from the contralateral limb in one case and a retrograde approach from the ipsilateral profunda artery in the other case. Angiography confirmed that the footplate of the Angio-Seal had occluded the femoral artery. Subsequently, the occlusion was crossed and a short balloon-mounted bare metal stent placed to push the footplate against the arterial wall that resulted in resolution of the occlusion and haemorrhage control. Conclusions Crossing the occlusion caused by failure of the Angio-Seal closure device and subsequent stenting resulted in satisfactory relief of the femoral artery occlusion and haemostasis without the added risks of open surgical revascularisation and general anaesthetic.
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Affiliation(s)
- Thomas C Hall
- Department of Radiology, Queen's Medical Centre (QMC), Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Said Habib
- Department of Radiology, Queen's Medical Centre (QMC), Nottingham University Hospitals NHS Trust, Nottingham, UK
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12
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Watanabe Y, Hozawa K, Ishiguro H, Nakamura S. Off-label use of Angio-Seal vascular closure device for the repair of femoral pseudoaneurysm after transfemoral coronary intervention. J Vasc Surg Cases Innov Tech 2019; 5:38-40. [PMID: 30740578 PMCID: PMC6355462 DOI: 10.1016/j.jvscit.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/03/2018] [Indexed: 12/03/2022]
Abstract
Pseudoaneurysm was caused at the puncture site of the left groin after percutaneous coronary intervention. Balloon tamponade was attempted for hemostasis at the aneurysmal site. However, hemostasis was not achieved. Next, direct puncture of the pseudoaneurysm was tried. A 0.014-inch guidewire was crossed from the neck of the pseudoaneurysm to the left common femoral artery. The wire was replaced with a 0.035-inch guidewire. An 8F Angio-Seal (Terumo Interventional Systems, Somerset, NJ) was inserted, and a collagen plug was deployed at the neck of the pseudoaneurysm. Final angiography revealed completion of hemostasis. Three-dimensional computed tomography angiography after 8 months revealed no evidence of recurrence.
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Affiliation(s)
| | | | | | - Sunao Nakamura
- Correspondence: Sunao Nakamura, MD, PhD, Department of Interventional Cardiology Unit, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
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Sato M, Matsumaru Y, Sakai N, Imamura H, Hirohata M, Takeuchi Y, Matsumato Y, Suzuki I. Usefulness of an access-site hemostasis device in neuroendovascular treatment. Acta Neurochir (Wien) 2017; 159:2331-5. [PMID: 28831587 DOI: 10.1007/s00701-017-3299-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We examined the safety and efficacy of the access-site hemostasis device Angio-Seal™ STS Plus (AS; St. Jude Medical,St. Paul, MN, USA) compared with the method of hemostasis by manual compression (MC) in neuroendovascular therapy. METHOD We conducted a prospective multicenter registration study enrolling 229 patients who were scheduled to undergo endovascular treatment. RESULTS Of the 119 and 110 cases assigned to the AS and MC groups, 118 (99.2%) and 105 (95.5%) achieved successful hemostasis, respectively. Six AS patients and 38 MC patients had access-site hematoma (5% vs 34.5%, P < 0.001). Hemostasis time was significantly shorter in the AS group than in the MC group (4.4 min vs 150.7 min, P < 0.001). Puncture-site hematoma was significantly larger in the AS group than the MC group (5.5 cm vs 2.9 cm, P < 0.05). Patients in the AS group had a significantly shorter hospital stay than those in the MC group (8.7 days vs 13.3 days, P < 0.001); they also had a significantly shorter time before they could start to walk (23.9 h vs 52.2 h, P < 0.001). No serious adverse events were noted in either group. Minor adverse events included four cases from the AS group and two cases from the MC group. CONCLUSIONS Use of an access-site hemostatic device resulted in quick and reliable access-site hemostasis in neuroendovascular therapy. When using AS, it is necessary to be careful when there is a possibility of a hematoma, as the hematomas, though significantly less frequent than in MC, were significantly bigger in that group.
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Abstract
Iatrogenic common femoral artery pseudoaneurysm is a well-described vascular access complication. Several methods have been proposed to treat these pseudoaneurysms. In this report, we present three cases of successful pseudoaneurysm closure using a novel method of retrograde pseudoaneurysm access and thrombosis with Angio-Seal (St Jude Medical, St Paul, MN) closure device. This technique appears safe, effective, and reduces patient discomfort.
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Affiliation(s)
- Jon Robken
- Genesis Heart Institute, Davenport, Iowa
| | - Nicolas W Shammas
- Genesis Heart Institute, Davenport, Iowa; Midwest Cardiovascular Research Foundation, Davenport, Iowa
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Babaev A, Gokhale R, Zavlunova S, Attubato M. Treatment of Angio-Seal-Related Femoral Artery Occlusion Using Directional Atherectomy-Primary Results and Midterm Follow-Up. Vasc Endovascular Surg 2016; 50:541-546. [PMID: 27852881 DOI: 10.1177/1538574416679520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We describe a novel approach for the endovascular treatment of femoral artery occlusion as a result of Angio-Seal closure device deployment. BACKGROUND Angio-Seal is the most commonly used vascular closure device following percutaneous coronary and peripheral catheterizations worldwide. A rare complication of Angio-Seal deployment is an occlusion of the femoral artery leading to limb ischemia requiring revascularization. Given its unique ability to cut both atherosclerotic plaque and the Angio-Seal anchor with a collagen plug at operator-directed planes, TurboHawk/HawkOne atherectomy device can be a fast and effective approach to treat Angio-Seal-associated femoral artery occlusions. METHODS We studied 13 consecutive patients who developed Angio-Seal-associated femoral artery occlusions that occurred from 3 hours to several weeks after catheterization. These patients were successfully treated with TurboHawk/HawkOne directional atherectomy followed by balloon angioplasty with no complications. During a mean follow-up period of 20.4 ± 17.3 months, 12 patients remained claudication free with no evidence of obstructive arterial disease of the treated segment on imaging studies. One patient developed restenosis that was treated with repeat atherectomy and balloon angioplasty following which he was asymptomatic at follow-up. CONCLUSION The use of directional atherectomy followed by balloon angioplasty is a quick, safe, and effective endovascular approach to treating Angio-Seal-associated femoral artery occlusions. It is associated with an excellent success rate, no complications, and good midterm outcomes.
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Affiliation(s)
- Anvar Babaev
- 1 Division of Cardiology, Department of Medicine, New York University, NY, USA
| | - Rohit Gokhale
- 1 Division of Cardiology, Department of Medicine, New York University, NY, USA
| | - Susanna Zavlunova
- 1 Division of Cardiology, Department of Medicine, New York University, NY, USA
| | - Michael Attubato
- 1 Division of Cardiology, Department of Medicine, New York University, NY, USA
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Dettmers RC, Bosman WMPF, van den Broek MAJ, Veger HTC, Hedeman Joosten PPA, Borger van der Burg BLS. A Peculiar Case of a Floating Angio-Seal. Open Cardiovasc Med J 2016; 10:44-7. [PMID: 27053966 PMCID: PMC4797688 DOI: 10.2174/1874192401610010044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/20/2015] [Accepted: 09/22/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose To show a complication of the use of an Angio-Seal™ closure device. Case We present a patient with a systolic murmur in his femoral artery after PCI. The murmur was caused by a dislocated Angio-Seal™, a vascular closure device. This was diagnosed by Doppler Ultrasound. The device was surgically removed. Conclusion Vascular complications, such as lower limb ischemia, requiring surgical intervention tend to be higher after use of a vascular closure device. We advise routine physical examination of the puncture site after percutaneous closure with a vascular closure device, such as an Angio-Seal™. The removal of the device can be performed via an open or endoscopic approach, based on available experience.
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Affiliation(s)
- R C Dettmers
- Rijnland Hospital, Department of Surgery, Leiderdorp, the Netherlands
| | - W M P F Bosman
- Rijnland Hospital, Department of Surgery, Leiderdorp, the Netherlands
| | | | - H T C Veger
- Rijnland Hospital, Department of Surgery, Leiderdorp, the Netherlands
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Manolis AS, Georgiopoulos G, Stalikas D, Koulouris S. 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 DOI: 10.1016/j.ihj.2015.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chung J, Lee DW, Kwon OS, Kim BS, Shin YS. Angio-Seal™ Evolution™ versus Manual Compression for Common Femoral Artery Puncture in Neurovascular Diagnostic Angiography : A Prospective, Non-Randomized Study. J Korean Neurosurg Soc 2011; 49:153-6. [PMID: 21556234 DOI: 10.3340/jkns.2011.49.3.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/21/2011] [Accepted: 03/03/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This prospective, non-randomized study compared the safety and efficacy of the Angio-Seal™ Evolution™ to that of manual compression for common femoral artery punctures in neurovascular diagnostic angiography. METHODS From June 2009 to September 2009, we performed 169 diagnostic trans-femoral cerebral angiographies, using either the Angio-Seal™ Evolution™ or manual compression to achieve hemostasis. We included 60 patients in this study, 30 in each group. We defined minor complications as those requiring no further treatment such as hematoma size less than 6 cm and bruise size less than 25 cm. Major complications were those requiring surgery of the femoral artery pseudoaneurysm and/or the second line increase of hospital stay even without further treatment. RESULTS Mean time to hemostasis was 0.42±0.04 minutes for the angioseal and 15.83±1.63 minutes for manual compression (p<0.001). Overall complication rate did not differ between the 2 groups. After the patients were fully mobile, at 24 hours, the rate of onset of new complication differed significantly between the 2 groups (p=0.032). In the angioseal group, 5 (16.7%) of the 30 patients experienced the onset of a new complication after 24 hours, including 3 (60.0%) of the 5 who experienced major complications. CONCLUSION The Angio-Seal™ Evolution™ is effective at decreasing mean time to hemostasis, like other closing devices. However, it may not be effective at producing early ambulation and discharge, compared to manual compression, because delayed complications may occur significantly after 24 hours.
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Affiliation(s)
- Joonho Chung
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
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