Femoral artery occlusion with a percutaneous arterial closure device after a routine coronary angiogram: a case report and literature review

Abstract

Groin vessels are most commonly used to obtain vascular access for angiography because of their size and accessibility. Haemostasis at the puncture site can be achieved with manual compression alone or by using a vascular closure device.We highlight the case of a 68-year-old woman who developed acute claudication in the right leg after a routine diagnostic coronary angiogram when an Angio-Seal ™ device had been employed to close a relatively low arterial puncture. On exploring the common femoral artery, fragments of the device were found occluding the bifurcation. A patch angioplasty was carried out and the patient's claudicant symptoms improved.The Angio-Seal ™ device has a polylactide and polyglycolide polymer anchor, a collagen plug and a suture contained within a carrier system. Haemostasis is achieved by compressing the arterial puncture site between the anchor and the collagen plug. The manufacturer's recommended criterion for using the device safely permits its use only for common femoral artery punctures with an internal vessel diameter of 4mm. Anatomical confirmation of the puncture site and evidence of any arterial disease or stenosis in the artery is detected on fluoroscopy during the procedure. Recent meta-analyses have cast doubt on the assumption that vascular closure devices are superior to mechanical compression alone and serious complications do occur occasionally but are under-reported. Clinicians should be aware of the potentially serious problems that may occur when deciding to employ vascular closure devices, especially with an anatomically low puncture site. 2011; 93: e102-e104 Ann R Coll Surg Engl

Risk Factors for Puncture Site Complications After Endovascular Procedures in Patients With Peripheral Arterial Disease

“…6 Moreover, studies show that the use of vascular closure devices, especially devices where a foreign body is left inside the vessel, may lead to more severe complications. [13][14][15][16] We were able to identify risk factors for development of complications at femoral access sites. Age is a known risk factor for vascular complications in percutaneous coronary interventions, perhaps related to the presence of more severe atherosclerosis and multiple comorbidities in the elderly individuals.…”

Comparison of controlled pressure belt -allowing mobility- to sandbags after percutaneous coronary intervention: pilot study

“…. [9][10][11] Use of Anjiobelt ® decreases the frequency of hematoma formation significantly relative to sandbags. Since our device exerts adjustable pressure on the femoral artery, it also prevents risk of ischemic complications.…”

Vascular puncture site complications - diagnosis, therapy, and prognosis

“…In particular, closure devices with an action that is provided by collagen-plugs ligated to the inside of the punctured vessel carry the risk for stenosis by plaque-shift, dissection or delayed thrombosis via reaction of the surrounding vessel to the plug itself [66]. Such complications are rare and almost limited to utilisation in diseased vascular districts or incorrect (too low) placement.…”