Common femoral artery stenosis after deployment of vascular clip closure device

We describe a case of symptomatic common femoral artery stenosis following use of a vascular clip closure device (StarClose). Operative repair was performed, with removal of the clip device and subsequent vein patch angioplasty. © 2008 Wiley‐Liss, Inc.     

适合Angioseal封堵器的股动脉穿刺法

目的　探讨使用Angioseal封堵器的股动脉穿刺方法。方法　总结了 80例冠状动脉介入诊疗术后 ,Angioseal封堵器的运用情况 ,将血管穿刺法按血管内口与入皮口的水平距离分为两组 ,两者距离小于 1 5cm为A组 ,大于 1 5cm为B组。观察穿刺成功率、并发症发生率。结果　A组病人成功率较高、并发症较低。结论　采用在腹股沟韧带下方一横指处准确定位穿刺内口 ,在水平距离1 5cm处确定入皮口的穿刺法 ,穿刺成功率高且安全。     

Same-day discharge after coronary stenting: a feasibility study using a hemostatic femoral puncture closure device

A major limiting factor for percutaneous coronary interventions carried out via the femoral route is the time it takes to achieve femoral artery hemostasis and subsequent mobilization. Discharge from hospital usually occurs the following day. In this pilot study, we assessed the feasibility of mobilization at 4 hours and same-day discharge from hospital of selected elective patients undergoing intracoronary stenting using the Angio-Seal Vascular Closure device. Seventy-five patients (56 +/- 10 years) with stable single-vessel coronary disease scheduled for elective coronary stenting were enrolled. All patients were mobilized at 4 hours and assessed at 10 hours postprocedure as to their suitability for hospital discharge. The first 50 patients remained in hospital overnight. The next 25 patients followed the same procedures but were discharged at 10 hours. The subjects were followed up at 48 hours and 30 days. Hemostasis was achieved in all patients following sheath removal and deployment of the Angio-Seal device. Twenty patients (27%) had minor groin oozing and two developed small hematoma. There were no major bleeding complications, pseudoaneurysm, vascular surgery, or groin infection. Groin oozing resulted in the delay of ambulation for 13 subjects but discharge was not delayed in any patient. All patients were reported to be suitable for hospital discharge at 10 hours postprocedure. There were no further complications at 30 days. The present study demonstrated that early mobilization and same-day discharge after coronary stenting using the Angio-Seal device is feasible in selected patients. Further studies are needed to determine the patient selection criteria and the potential cost-saving implications of this strategy.     

Femoral artery occlusion after using a suture‐mediated arterial puncture closure device

A femoral artery occlusion is a very rare complication after using a suture‐mediated arterial puncture closing device (APCD). The mechanism of the femoral artery occlusion is unclear and its standard management has not been established. This case describes a mechanism of femoral artery occlusion by a suture‐mediated APCD and suggests a method of prevention and treatment. © 2008 Wiley‐Liss, Inc.     

Laser angioplasty of peripheral arteries after unsuccessful recanalization of the superficial femoral artery

AIM: To demonstrate the range of applying laser angioplasty after unsuccessful recanalization of the superficial femoral artery (SFA) with conventional interventional techniques. MATERIALS AND METHODS: In a prospective trial in 94 cases with occlusion of the SFA and formerly unsuccessful conventional percutaneous transluminal angioplasty, laser angioplasty for recanalization was applied. The average length of the SFA was 17.5 cm (range 4–36 cm). The recanalization attempt was made using the crossover technique in 78 patients, in eight patients with the antegrade technique and in another eight patients using the transpopliteal technique. The primary recanalization attempt was performed with Terumo wires (curved and straight) as well as different catheters (Multipurpose/Vertebralis/Cobra). the unsuccessful recanalization attempt the laser catheter was applied. RESULTS: The application of laser angioplasty demonstrated a successful recanalization of the SFA in 76/94 patients (80.9%). In 18 patients (19.1%) the recanalization was not possible even with percutaneous transluminal laser angioplasty (PTLA). The reason for the unsuccessful PTLA was in 10 cases due to obstructing calcified material, which was resistant to PTLA application. In four cases obstructing calcifications caused the laser catheter to be positioned in subintimal tissue, resulting in perforation occlusion of the SFA. In another four patients there was an aberrant anatomy of the SFA which resulted in a direct vessel injury after advancing the laser catheter. After a follow-up period of 12 months primary, primary-assisted and secondary patency rates were 50.0%, 65.8% and 73.7%, respectively. DISCUSSION: In primarily unsuccessful recanalization of the SFA, PTLA allows in After 80% of cases a successful recanalization of the SFA. The technical success rate and the patency rate support the application of PTLA. (Int J Cardiovasc 2000; 3: 153–160)     

Novel femoral artery puncture closure device in patients undergoing interventional and diagnostic cardiac procedures.

BACKGROUND: The wide range of closure devices for arterial access sites still leaves room for improvement. METHODS AND RESULTS: We report our initial experience with a novel, cost-effective, suture-mediated device (6 French X-PRESS device, X-SITE Medical, Blue Bell, Pennsylvania) for closure of the arterial access site after both diagnostic and therapeutic interventions. A total of 51 consecutive patients are reported. The closure was performed immediately after the procedure. No patient had more than 5,000 U heparin administered during the procedure. The closure device was used in 36 patients (73%) after diagnostic angiography and in 15 patients (27%) after therapeutic intervention. The device could be successfully deployed in 48 patients (94%). In the remaining 3 cases (6%), hemostasis was achieved with standard manual compression without any further event. Immediate total hemostasis was achieved with the device in 44 of 48 patients (92%). Four devices (8%) could not be deployed correctly due to technical problems and the patients needed additional manual compression. The average time to achieve complete hemostasis was 5.5 +/- 3.5 minutes (range, 3-26 minutes). The patients were ambulated after a period of 1.3 +/- 0.4 hours of bedrest (range, 0.8-3.5 hours). Time to possible discharge was 4.2 +/- 3.4 hours (range, 0.9-12.5 hours). One patient experienced a minor complication (hematoma < 6 cm) and was treated with manual compression without clinical sequelae. Telephone follow-up was carried out 2 weeks after deployment and revealed no sequelae. CONCLUSION: The 6 French X-PRESS device is safe and effective in providing rapid hemostasis following interventional or diagnostic catheterization procedures. Use of the device is associated with a low rate of complications and facilitates quick hemostasis, mobilization and discharge.     

First experience with the use of a clip device for closure of arterial approach after endovascular treatment of coronary arteries

Aim of the present study was assessment of the StarClose Vascular Closure System - novel device for mechanical closure of femoral artery puncture site. We included in this study 29 patients in whom after procedure of endovascular treatment puncture site was closed with the given device. Control group comprised 34 patients in whom hemostasis was conducted by way of manual compression of puncture site according to standard technique. Femoral artery was clipped immediately after completion of the stenting procedure irrespective of the last result of activated partial thromboplastin time measurement. Success of the use of the StarClose was 100%. Activation of a patient was undertaken substantially earlier compared with the group of manual hemostasis. Sitting up in bed was performed in 2 hours after completion of hemostasis procedure compared with 16 hours in control group, walking within ward was started in 3.5 hours compared with 17 hours in control group ( < 0.0001 in both cases). Duration of the procedure of hemostasis was substantially smoller in the group of closing device compared with the group of manual hemostasis (1.7 and 23 min, respectively). With this no complications from the site of puncture were observed in the group of closing device. In the group of manual hemostasis one patient (2.9%) had hematoma nor requiring special treatment and in one more patient (2.9%) after violation of bed regimen minor bleeding occurred from puncture site (was eliminated by additional manual compression for 20 min). Total number of complications in the group of manual compression was 5.8%. Thus compared with traditional manual hemostasis. The use of StarClose clip device allows to activate patients after endovascular treatment substantially earlier.     

Use of a percutaneous vascular suture device for closure of an inadvertent subclavian artery puncture.

A well-known complication of central venous catheterization is inadvertent arterial sheath placement. Sheath removal from noncompressible arteries has the potential for severe complications. We report a case of inadvertent subclavian arterial sheath placement during an attempted internal jugular venous catheterization. This was successfully removed using a percutaneous vascular suture device.     

Retroperitoneal hematoma: An unexpected complication during intervention on an occluded superficial femoral artery via a retrograde popliteal artery approach

Peripheral arterial disease involvement of the superficial femoral artery (SFA) is common. Different endovascular techniques are used successfully for revascularization of this artery. A retrograde approach to chronic total occlusion (CTO) of the SFA through the ipsilateral popliteal artery has been used occasionally if an antegrade approach is not feasible or has failed. Some of the known complications encountered during this approach are arteriovenous fistula formation at the access site, occlusion of the popliteal artery if closure devices are used, and bleeding. There are no reports of perforation or bleeding of the SFA or the external iliac artery (EIA) during a popliteal approach, probably due to lack of flow in the occluded segment of the SFA. We report a case in which a retroperitoneal hematoma occurred due to retrograde blood flow through the established true channel in the proximal SFA and subsequently to the dissection plane with a wire tip perforation in the EIA, which was treated by stopping retrograde filling with prolonged balloon inflation in the distal SFA before the CTO.     

Initial experience with a new compression device for hemostasis after femoral arterial puncture.

We evaluated a new hemostasis device to maintain focused pressure over the femoral artery puncture site for 2-6 hours in 330 cases after diagnostic catheterization or coronary angioplasty. No patient developed later hematoma or vascular complications. The initial favorable experience suggests that this hemostasis device has advantageous features of stability and site visualization and is a suitable adjunct to current methods of maintaining puncture site pressure after brief manual compression following arterial catheterization.     

Late clinical presentation of femoral artery occlusion after deployment of the angio-seal closure device

We report a case of late femoral artery thrombosis after deployment of the Angio-Seal closure device. The unusual late clinical presentation, aggressive anticoagulation which likely delayed clinical symptoms and the challenging surgical findings are discussed. Physicians need to be alert for possible complications arising late after deployment of closure devices and vascular surgeons must be familiar with the design of these devices since they may be required to repair a variety of arterial injuries associated with their use.     

Percutaneous popliteal approach for angioplasty of superficial femoral artery occlusions

Angioplasty using the percutaneous popliteal approach was utilized in 50 patients (PTS) to recanalize 59 occluded superficial femoral arteries which had been unsuccessfully canalized by using the antegrade approach because of either a flush origin occlusion or inability to maintain the guide wire in the true lumen. All PTS had claudication; 8 had rest pain; 3 had non-healing ulcers. The laser Probe was used in 17 cases and the Rotablator in 3 cases. Occlusion length varied between 1 and 40 cm: 7 lesions were less than 10 cm (group 1); 9 were between 10 and 20 cm (group 2); and 43 were greater than 20 cm (group 3). An angiographic success was obtained in 48/59 lesions (81%): 14/16 (87%) in groups 1 and 2 and 34/43 (79%) in group 3. Three PTS needed complementary common femoral endarterectomy and one required percutaneous aspiration of a thromboembolus. Complications included: arterial perforation and/or dissection (without clinical sequelae) in 11 and a popliteal hematoma in 1 PT. One patient with a severely ischemic leg underwent successful emergency vascular surgery, while another limb salvage patient required below-knee amputation. There was no worsening of limb ischemia from any popliteal approach attempt. At discharge, 39 patients (78%) whose outcome would have been unsuccessful with the traditional antegrade approach were clinically improved after utilizing the popliteal approach to achieve a successful angioplasty procedure.     

Left axillary approach for balloon recanalization of an occlusion of the right common femoral artery.

Percutaneous angioplasty of an occlusion of the right common femoral artery was attempted through the left axillary route. The problem of negotiating the occlusion was solved by the use of Magnum guidewire and a Probing catheter. Symptomatic improvement was achieved and there were no complications at the puncture site.     

经冠状动脉侧介入治疗先天性冠状动脉瘘的安全性及效果分析

目的:评价应用不同封堵器经冠状动脉侧治疗先天性冠状动脉瘘(CAF)安全性及效果。方法:2012年至2015年间,连续12例患者(年龄18~62岁,男性7例,女性5例)在本中心确诊为冠状动脉瘘并试行经导管介入封堵术,封堵前完成血液动力学评估及冠状动脉造影,依造影结果选择封堵器。结果:12例患者共存在13处瘘口,1例为双支病变。9例成功完成介入封堵术,1例因新瘘再形成行二次介入,故累计完成10例封堵术。使用ADO II封堵器4例,纤维弹簧圈3例,电离弹簧圈2例,血管塞联合弹簧圈1例。术后造影2例存在少量残余分流,其中1例随访中新瘘再生。无冠状动脉损伤或冠状动脉内血栓形成等并发症发生。中位随访时间15.2个月。结论:经冠状动脉侧置入封堵冠状动脉瘘安全有效,术式更为简便易行。     

Isolated femoral profundoplasty using endarterectomised superficial femoral artery for limb salvage in the elderly

BACKGROUND: The deep femoral artery provides the primary blood supply to the thigh, and in addition serves as the major collateral channel for bypassing the obstructed superficial femoral artery. The purpose of isolated profundoplasty is to relieve a significant stenosis and improve perfusion of the ischaemic leg. METHODS: Twenty-seven patients with critical limb ischaemia underwent isolated profundoplasty in the Vascular Unit of Meir General Hospital, using endarterectomised superficial femoral artery (ESFA) as an arterial patch. Nineteen patients were men. The average age was 72 (65-79). The presenting symptoms: rest pain: 18 (67%), ischaemic foot ulcer: 7 (28%), pedal gangrene: 2 (7%). Selection criteria for isolated profundoplasty: 1) > 50%: stenosis of arteria profunda femoris lumen. 2) Adequate profunda: popliteal collateral system. 3) Adequate arterial inflow: common femoral artery. RESULTS: There was no operative mortality or immediate operative failure. All 27 limbs were improved: relief of rest pain, healing of ischaemic ulcers and good healing after minor amputations (transphalangeal, transmetatarsal). Follow-up period ranged from 12 to 45 months (mean 30 months) and was based on clinical investigation + ankle/brachial Doppler measurements. All patients remained asymptomatic with improvement of limb function--either to the present or until their death. CONCLUSIONS: In view of our favourable experience, we feel that isolated profundoplasty still has a place in vascular surgery practice--when limb revascularization in elderly patients considered at high risk is dangerous and when there is impossible below knee vascular reconstruction. We recommend the use of ESFA as a patch for long segment profundoplasty--with all advantages of an autogenous material.     

Stenosis-jet can cause a dissection of the superficial femoral artery.

A dissection of the superficial femoral artery mainly occurs due to trauma or manipulation of the artery by means of interventional procedures. In contrast to dissections of the carotid arteries which are known to occur spontaneously we present the case of a stenosis of the superficial femoral artery that led to a dissection caused by the stenosis-jet. The dissection on the other hand caused an appositional thrombus which led to the embolic occlusion of the pedal-arteries. In case of peripheral embolisms in patients with or without history of peripheral arterial occlusion disease it is important to look for a causing arterial pathology preferably by duplex sonography.