Successful endovascular extraction of newer generation Angio-Seal collagen plug and anchor after acute embolization

Abstract

A 75-year-old woman with past medical history of coronary bypass, atrial fibrillation, mitral valve repair undergoes percutaneous coronary intervention of left circumflex artery with a drug eluting stent. An Anglo-Seal vascular closure device was used post procedure to obtain hemostasis. Shortly after deployment, frank bleeding was observed necessitating manual compression at the arteriotomy site. After hemostasis was achieved, the right lower extremity was found to be pale, bluish with feeble pulses. Doppler ultrasound was emergently performed revealing decreased blood flow after mid superficial femoral artery (SFA) and an echo lucent object lodged luminally in the SFA. Patient was urgently taken to the vascular laboratory where an Angio-Seal device, including the collagen plug and anchor, was successfully removed endovascularly patient made full recovery and was discharged home the following day.

Endovascular snare retrieval of an Angio‐Seal causing acute limb ischemia

“…There are previous reports of endovascular Angio-Seal removal, but these attempts have been complicated by difficult direct visualization, with partial retrieval or distal embolization following manipulation. 5,6 Rafeh et al describe a fluoroscopic guided attempt to capture a dislodged Angio-Seal in the right SFA with a Spider RX 7 mm filter device (Covidien) via a 7F sheath in the left CFA. 5 Jud et al described a similar technique, using a Spider RX 7 mm filter to capture an embolized Angio-Seal anchor embolized to the posterior tibial artery at the ankle's level.…”

“…5,6 Rafeh et al describe a fluoroscopic guided attempt to capture a dislodged Angio-Seal in the right SFA with a Spider RX 7 mm filter device (Covidien) via a 7F sheath in the left CFA. 5 Jud et al described a similar technique, using a Spider RX 7 mm filter to capture an embolized Angio-Seal anchor embolized to the posterior tibial artery at the ankle's level. 7 A similar approach to our technique was performed by Palmer et al 8 Retrieval of a malpositioned Angio-Seal was achieved using a 2-to 4-mm retrieval snare (Atrieve; Argon Medical Devices, Inc) and an 8F sheath via a contralateral access.…”

Successful Retrieval of an Embolized Vascular Closure Device (Angio-Seal®) After Peripheral Angioplasty

“…There are limited data on endovascular retrieval of an isolated Angio-Seal ® anchor without thrombus or collagen sponge. Abi Rafeh et al [12] reported successful endovascular extraction of newer generation Angio-Seal ® collagen plug and anchor after acute embolization using a Spider ® RX 7-mm filter device (Covidien, Plymouth, MN, USA). We considered aspiration of the anchor and evaluated therefore aspiration catheters of various sizes.…”

Fluoroscopy‐guided snare retrieval of the celt ACD® metallic vascular closure device following failed deployment

“…The Celt ACD ® is unique in its high‐visibility on fluoroscopy, and while intended to permit remote re‐puncture, this aided endovascular retrieval in this case. There are previous reports of endovascular removal of Angio‐Seal ® VCDs, but these attempts have been complicated by difficult direct visualization, with partial retrieval or distal embolization following manipulation . Previous endovascular strategies have employed use of the Simpson atherectomy device, gooseneck catheter, and Fogarty balloon retrieval.…”