Incidence of Vascular Injuries after Use of the Angio-Seal Closure Device following Endovascular Procedures in a Single Center |
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Authors: | Patrizio Castelli FACS MD Roberto Caronno MD Gabriele Piffaretti MD Matteo Tozzi MD Chiara Lomazzi MD |
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Institution: | (1) Department of Surgery, Division of Vascular Surgery, University of Insubria, Viale Borri 57, Varese, 21100, Italy;(2) Vascular Surgery, University of Insubria, Ospedale di Circolo, Viale Borri 57, Varese, 21100, Italy |
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Abstract: | Introduction Percutaneous closure devices have been used to obtain rapid hemostasis and early mobilization of the patient after arterial
catheterization. However, we observed challenging problems with the sealing procedure that require further surgical intervention.
The present report is a retrospective analysis of the patterns of injury and the final outcome of four cases of femoral artery
injury following the use of Angio-Seal.
Methods During the last 24 months, in a group of 175 patients (131 men, 44 women; median age 68.4 years, range 47–81 years) underwent
percutaneous closure after diagnostic (n = 53) or therapeutic (n = 122) endovascular procedures. Among them we observed four patients (three men, one woman; median age 65.2 ± 10.8 years,
range 47–75 years) who developed severe limiting claudication and required vascular repair of an iatrogenic vascular injury
following deployment of the Angio-Seal. They had a femoral thrombosis due to narrowing/severe intimal dissection.
Results All patients required operative intervention with removal of the device. We performed femoropopliteal thrombectomy and common
femoral endarterectomy with patch angioplasty (n = 2), resection of the femoral bifurcation and reimplantation of the deep femoral artery (n = 1), and femoral bifurcation endarterectomy with direct arterial suture (n = 1). The median hospital stay was 6.5 ± 3.8 days (range 4–12 days). Limb salvage was achieved in all of the surviving patients
at a mean follow-up of 7 months (range 1–12 months).
Conclusions Vascular injuries are uncommon after use of the hemostasis closure device. When they occur, however, they are likely to require
challenging surgical correction.
This work was presented at the 4th International Central European Vascular Forum in Dubrovnijk, April–May 2004. |
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