Obesity: An Independent Risk Factor for Insufficient Hemostasis Using the AngioSeal Vascular Closure Device After Antegrade Puncture

Minko, Peter; Katoh, Marcus; Gräber, Stefan; Buecker, Arno

doi:10.1007/s00270-011-0230-y

Cited by 35 publications

(24 citation statements)

References 12 publications

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“…On baseline analyses, patients who were treated with a CD had a higher proportion of obesity, which has previously been reported to independently predict access site complications in patients undergoing antegrade PVI, even when a CD was used. 12 The burden of overall atherosclerotic disease was lower in the CD group compared with the no CD group, as indicated by a lower proportion of patients with a history of CAD, CABG, PCI, major amputation, and previous inflow or infrainguinal stent, angioplasty, or bypass. Patients receiving an intervention owing to occlusive disease were also less likely to be treated with a CD.…”

Section: Discussionmentioning

confidence: 87%

Antegrade common femoral artery closure device use is associated with decreased complications

Ramirez

Zarkowsky²,

Sorrentino

et al. 2020

Journal of Vascular Surgery

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Antegrade common femoral artery closure device use is associated with decreased complications.ABSTRACT Objective: Antegrade femoral artery access is often used for ipsilateral infrainguinal peripheral vascular intervention. However, the use of closure devices (CD) for antegrade access (AA) is still considered outside the instructions for use for most devices. We hypothesized that CD use for antegrade femoral access would not be associated with an increased odds of access site complications.Methods: The Vascular Quality Initiative was queried from 2010 to 2019 for infrainguinal peripheral vascular interventions performed via femoral AA. Patients who had a cutdown or multiple access sites were excluded. Cases were then stratified into whether a CD was used or not. Hierarchical multivariable logistic regressions controlling for hospital-level variation were used to examine the independent association between CD use and access site complications. A sensitivity analysis using coarsened exact matching was performed using factors different between treatment groups to reduce imbalance between the groups.Results: Overall, 11,562 cases were identified and 5693 (49.2%) used a CD. Patients treated with a CD were less likely to be white (74.1% vs 75.2%), have coronary artery disease (29.7% vs 33.4%), use aspirin (68.7% vs 72.4%), and have heparin reversal with protamine (15.5% vs 25.6%; all P < .05). CD patients were more likely to be obese (31.6% vs 27.0%), have an elective operation (82.6% vs 80.1%), ultrasound-guided access (75.5% vs 60.6%), and a larger access sheath (6.0 6 1.0 F vs 5.5 6 1.0 F; P < .05 for all). CD cases were less likely to develop any access site hematoma (2.55% vs 3.53%; P < .01) or a hematoma requiring reintervention (0.63% vs 1.26%; P < .01) and had no difference in access site stenosis or occlusion (0.30% vs 0.22%; P ¼ .47) compared with no CD. On multivariable analysis, CD cases had significantly decreased odds of developing any access site hematoma (odds ratio, 0.75; 95% confidence interval, 0.59-0.95) and a hematoma requiring intervention (odds ratio, 0.56; 95% confidence interval, 0.38-0.81). A sensitivity analysis after coarsened exact matching confirmed these findings. Conclusions:In this nationally representative sample, CD use for AA was associated with a lower odds of hematoma in selected patients. Extending the instructions for use indications for CDs to include femoral AA may decrease the incidence of access site complications, patient exposure to reintervention, and costs to the health care system. (J Vasc Surg 2020;-:1-8.)

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Section: Discussionmentioning

confidence: 87%

Antegrade common femoral artery closure device use is associated with decreased complications

Ramirez

Zarkowsky²,

Sorrentino

et al. 2020

Journal of Vascular Surgery

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“…So far, only obesity has been reported as an independent risk factor for deployment failure in antegrade punctures. 22 In contrast though, other papers examining this issue in the context of percutaneous EVAR have suggested that BMI is not relevant to VCD deployment success rates, though of course punctures in such cases are by default retrograde. 23 It is certainly our experience that traversing through a fatty/deep groin in an antegrade fashion can create a right angle kinking the Angio-Seal sheath, which may contribute to deployment difficulty and failure.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Vascular Closure Using an Anchored Collagen Plug Provides Effective Haemostasis Following both Antegrade and Retrograde Femoral Arterial Punctures

Chaudhuri

York

Dey

2014

European Journal of Vascular and Endovascular Surgery

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“…The StarClose system, a clip based device, has a malfunction rate around 1.1%. AngioSeal, a well-established collagen plug induced vascular closure device, has been found to have malfunction rates up to 10% [13,14]. The majority of the device malfunctions occurred at the beginning of the Secure Device activation, so the device was able to be changed and did not influence the study procedure.…”

Section: Discussionmentioning

confidence: 99%

Thermic sealing in femoral catheterization: First experience with the Secure Device

et al. 2019

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Obesity: An Independent Risk Factor for Insufficient Hemostasis Using the AngioSeal Vascular Closure Device After Antegrade Puncture

Abstract: Obesity seems to be an independent risk factor for insufficient sealing using the AngioSeal vascular closure device after antegrade puncture of the CFA. In 8% of our patients, hemostasis could not be achieved due to kink of the flexible sheath.

Cited by 35 publications

References 12 publications

Antegrade common femoral artery closure device use is associated with decreased complications

Antegrade common femoral artery closure device use is associated with decreased complications

Percutaneous Vascular Closure Using an Anchored Collagen Plug Provides Effective Haemostasis Following both Antegrade and Retrograde Femoral Arterial Punctures

Thermic sealing in femoral catheterization: First experience with the Secure Device

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