Femoral-Popliteal versus Long Superficial Femoral Artery Stent

Abstract

Background:The ability to safely achieve hemostasis is a key aspect of percutaneous vascular access. Vascular closure devices (VCDs) were designed to improve the safety of vascular closure; however this has been difficult to prove in recent studies. We present our experience with achieving hemostasis including assessing the safety and efficacy of VCDs. The aim of this study is to assess the technical success, complications and associated risk factors for achieving hemostasis in antegrade femoral punctures for infrainguinal interventions. Method(s): A retrospective review of all patients who underwent antegrade common femoral puncture for infrainguinal endovascular procedures between January 2016 and November 2018. Access site hemostasis was achieved either using VCD or manual compression (MC). Patient demographics, body mass index (BMI), previous ipsilateral groin punctures and surgeries, skin to vessel distance, common femoral artery (CFA) diameter, sheath size and complications were recorded. Result(s): A total of 175 antegrade femoral punctures were performed in 159 patients. Mean patient age was 65 years (21-102). Male:female ratio was 120:39 patients and mean BMI was 27.2 (16.24-43.79). Mean CFA diameter was 7.5 mm (3.5-12.7 mm) and mean skin to vessel distance (SVD) was 33.7 mm (9.6-20 mm). Sheath sizes utilized were 5 Fr (n=93), 6 Fr (n=66), 4 Fr (n=13), and 7 Fr (n=3). MC was used to achieve hemostasis in 46% (n=81) of patients. Angioseal was the most commonly used VCD in 43.6% (n=41), Exoseal 36% (n=34) and Proglide in 20% (n=19). Technical success in the VCD group was 92.5% (n=87). Six patients experienced complications (VCD=4; MC=2) including groin hematoma, pseudoaneurysm, distal thromboembolism and arterial perforation. Conclusion(s): In our experience, vascular closure devices are effective and safe in antegrade arterial procedure with limited number of complications. A larger study is required to compare vascular closure devices in antegrade punctures.