AngioSeal (AS) and VasoSeal (VS) are collagen-based arterial closure devices utilized to achieve earlier hemostasis and ambulation in diagnostic and interventional percutaneous procedures. To our knowledge, there has been no randomized studies comparing these two devices as approved for use in the United States. One hundred fifty-seven patients were randomized to receive either the 8 Fr AS (n = 79) or VS (n = 78) closure device. Data on 95 patients who had coronary angiography (49 AS, 46 VS) and 55 patients who underwent angioplasty (28 AS, 27 VS) were completed. Heparin was not administered during the coronary angiogram procedure. The activated clotting time was kept at approximately 300 sec during angioplasty. Patients on coumadin or GP IIb/IIIa platelet inhibitors were not included in this study. The time unit interval to achieve hemostasis in this study was based on the time the AS tension spring was left over the common femoral artery following collagen deployment as per the manufacturer's instructions (20 min). Time to hemostasis, time to ambulation, and major and minor complications were prospectively recorded. Two-tailed t-test and chi-square analysis were performed on continuous and dichotomous variables, respectively. For the angiogram-only subgroup, time (min) to hemostasis (20.51 +/- 4.36 vs. 18.59 +/- 11.77; P = 0.30) and ambulation (145.71 +/- 124 vs. 109.89 +/- 60.37; P = 0.075) were not statistically different for the AS and VS, respectively. Similarly, for the angioplasty subgroup, time (min) to hemostasis (24.23 +/- 12.70 vs. 19.57 +/- 2.27; P = 0.077) and ambulation (607.32 +/- 344.22 vs. 486.48 +/- 200.37; P = 0.12) were not statistically different for both AS and VS, respectively. Furthermore, there were no statistical differences in deployment failure, major, minor, or total complication rates between the two devices. In the absence of GP IIb/IIIa inhibitors, VS and the 8 Fr AS devices have statistically similar time to hemostasis and ambulation as well as device failures and complication rates following coronary angiography and angioplasty.

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.

Retrograde recanalization of the SMA via celiac collaterals offers a new endovascular approach to treating patients with chronic mesenteric ischemia and a chronically occluded SMA.

Malignant lymphoma commonly involves the heart. Previous studies have found cardiac metastases in up to 20% of patients dying with lymphoma. Cardiac signs and symptoms of lymphoma are relatively rare, however, and in most cases, the diagnosis is made either postmortem or too late to affect the clinical course. This report presents the first case of complete heart block due to lymphoma that responded to surgery and chemotherapy with return of normal atrial ventricular conduction.

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