Changing Pattern of Access Site Complications with the Use of Percutaneous Closure Devices

Abstract

The authors report their experience with 15 cases of groin complications associated with the use of percutaneous closure devices following femoral arterial catheterization over a 2-year period. The complication rate was 1.7% for catheterizations in which a closure device was used. The 15 cases included 7 uncomplicated pseudoaneurysms (PSA), 3 infected pseudoaneurysms, 4 nonarterial groin infections (infected hematomas and/or abscesses), and 1 case of femoral artery occlusion. These complications presented at an average of 5 ±4 days postcatheterization. One patient with an infected PSA required a below-the-knee amputation. During the same time interval, there were no infectious complications in patients not receiving closure devices. We conclude that groin complications associated with such devices tend to present late and include a higher percentage of infections as opposed to complications occurring in patients not receiving closure devices. An aggressive surgical approach to these problems appears warranted.

Nonvalvular Cardiovascular Device–Related Infections

“…The enthusiastic acceptance of these devices has been tempered by a growing number of reports that indicate that (1) infectious complications are more common with hemostatic puncture closure devices than with manual compression and (2) infectious complications are more severe, more difficult to treat, and may require surgical intervention for attempted cure of infection. [152][153][154][155][156][157][158] The pathogen most often isolated in these infections is S aureus, and methicillin resistance among the strains has been described. The risk may be highest among diabetic patients, and the prophylactic use of a broadspectrum antibiotic is generally used with device placement in these patients.…”

The problematic inguinal wound in vascular surgery–What is the optimal treatment?

“…Due in part to to the nature of the mainly elderly patient population with many co-morbidities, wound problems are common, occurring in 2.5-22% of the patients [1,2]. With the new technologies, such as the use of stents and percutaneous closure devices, the complication pattern may be rapidly changing [3].…”

Allen or No Allen

“…Reports of leg amputation after transfemoral catheterization exist, and death can occur, directly resulting from femoral artery injuries or retroperitoneal bleeding. To date, no hand or finger amputation has been reported after TRA for diagnostic angiography or intervention, even though TRA has been used worldwide for >20 years (6). It is obvious that the generous and redundant vascularization of the hand by the radial, ulnar, and interosseous arteries provides protection against distal ischemia in case of RAO after catheterization (Fig.…”