Abstract
Purpose
This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia.
Methods
Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide® 6F, Abbott) was placed before arterial sheath (mean 9 F, range 6–12 F) introduction in 101 patients (74 men, 73 %, mean age 70.1 ± 12.6 years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6 month after the intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound.
Results
There were a total of 19 vascular complications (19 %) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2 %) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94 %); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered.
Conclusions
With acceptable short- and mid-term outcomes, the “preclose” technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectomy.
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References
Rutherford RB (2009) Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg 22(1):5–9
Sniderman KW, Bodner L, Saddekni S et al (1984) Percutaneous embolectomy by transcatheter aspiration. Work in progress. Radiology 150(2):357–361
Diffin D, Kandarpa K (2001) Percutaneous recanalization of peripheral arterial occlusions. World J Surg 25(3):312–317 discussion 317–318
Lee W, Brown M, Nelson P et al (2007) Total percutaneous access for endovascular aortic aneurysm repair (“Preclose” technique). J Vasc Surg 45(6):1095–1101
Bechara CF, Annambhotla S, Lin PH (2010) Access site management with vascular closure devices for percutaneous transarterial procedures. J Vasc Surg 52(6):1682–1696
Dosluoglu H, Cherr G, Harris L et al (2007) Total percutaneous endovascular repair of abdominal aortic aneurysms using Perclose ProGlide closure devices. J Endovasc Ther 14(2):184–188
Starck EE, McDermott JC, Crummy AB et al (1985) Percutaneous aspiration thromboembolectomy. Radiology 156(1):61–66
Patel N, Sacks D, Patel RI et al (2003) SIR reporting standards for the treatment of acute limb ischemia with use of transluminal removal of arterial thrombus. J Vasc Interv Radiol 14(9 Pt 2):S453–S465
Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17(8):857–872
Kussmaul WG, Buchbinder M, Whitlow PL et al (1995) Rapid arterial hemostasis and decreased access site complications after cardiac catheterization and angioplasty: results of a randomized trial of a novel hemostatic device. J Am Coll Cardiol 25(7):1685–1692
Chevalier B, Lancelin B, Koning R et al (2003) Effect of a closure device on complication rates in high-local-risk patients: results of a randomized multicenter trial. Catheter Cardiovasc Interv 58(3):285–291
Popma JJ, Satler LF, Pichard AD et al (1993) Vascular complications after balloon and new device angioplasty. Circulation 88(4 Pt 1):1569–1578
Moscucci M, Mansour KA, Kent KC et al (1994) Peripheral vascular complications of directional coronary atherectomy and stenting: predictors, management, and outcome. Am J Cardiol 74(5):448–453
Pracyk JB, Wall TC, Longabaugh JP et al (1998) A randomized trial of vascular hemostasis techniques to reduce femoral vascular complications after coronary intervention. Am J Cardiol 81(8):970–976
Duda S, Wiskirchen J, Erb M et al (1999) Suture-mediated percutaneous closure of antegrade femoral arterial access sites in patients who have received full anticoagulation therapy. Radiology 210(1):47–52
Sohail MR, Khan AH, Holmes DR et al (2005) Infectious complications of percutaneous vascular closure devices. Mayo Clin Proc 80(8):1011–1015
Van Den Broek T, Liqui Lung PF, Suttorp MJ et al (2007) Vascular occlusion as a late complication of the Angio-Seal closure device. A review of literature. Minerva Cardioangiol 55(6):815–819
Kalapatapu V, Ali A, Masroor F et al (2006) Techniques for managing complications of arterial closure devices. Vasc Endovasc Surg 40(5):399–408
Wille J, Vos JA, Overtoom TT et al (2006) Acute leg ischemia: the dark side of a percutaneous femoral artery closure device. Ann Vasc Surg 20(2):278–281
Derham C, Davies JF, Shahbazi R et al (2006) Iatrogenic limb ischemia caused by angiography closure devices. Vasc Endovasc Surg 40(6):492–494
Hoffer EK, Bloch RD (2003) Percutaneous arterial closure devices. J Vasc Interv Radiol 14(7):865–885
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Funke, C., Pfiffner, R., Husmann, M. et al. The Use of the “Preclosure” Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia. Cardiovasc Intervent Radiol 36, 377–384 (2013). https://doi.org/10.1007/s00270-012-0455-4
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DOI: https://doi.org/10.1007/s00270-012-0455-4