Korean Circ J.  2008 Jun;38(6):339-342. 10.4070/kcj.2008.38.6.339.

Three Cases of Arterial Occlusion That Occurred After the Use of Angioseal(R)

• Choi YH
• Namgung J
• Choe H
• Kwon SU
• Doh JH
• Lee SY
• Kim CY
• Chang WI
• Lee WR

• KMID: 2225783
• DOI: http://doi.org/10.4070/kcj.2008.38.6.339

Abstract

Femoral arterial closure devices are now commonly used after both diagnostic and therapeutic coronary procedures. They have been shown to reduce the time to ambulation and to decrease the length of the hospital stay. Angioseal is a commercially available femoral artery closure device that has been approved by the Food and Drug Administration (FDA). The device sandwiches an intra-arterial absorbable anchor on the luminal side of the vessel and a thrombin plug on the surface of the vessel with using a self-cinching stitch. We report here on three patients who presented with acute and delayed arterial occlusive complications that were found to be due to an Angioseal anchor that was not appropriately reabsorbed.

Keyword

Percutaneous coronary angioplasty; Femoral artery; Closure device

MeSH Terms

Femoral Artery
Glycosaminoglycans
Humans
Length of Stay
Phenobarbital
Thrombin
United States Food and Drug Administration
Walking
Glycosaminoglycans
Phenobarbital
Thrombin

Figure

• 

  Fig. 1 Images of the obstructive lesions at the distal portion of the femoral artery puncture site. The abdominal aortogram showed a completely occluded lesion in the right common femoral artery at the level of the femoral head, at the site of a previous puncture (A). CT angiography demonstrated completely diffuse occluded lesion in the right superficial femoral artery from a puncture site (B). Complete thrombotic occlusion (arrow) of the right popliteal artery was observed by CT angiography (C).

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  Fig. 2 Surgical findings of the occluded lesion. A large obstructive lesion (1.5×1.0 cm sized) was visible in the proximal superficial femoral artery (A). This mass-like lesion was attached to the intima and it was easily detached from the vessel wall by forceps. The mass was nodular, hard and yellowish in color and showed red colored pigmentation from blood and brownish coloration from the thrombus (B).

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  Fig. 3 Microscopic findings of the surgically detached lesion. Amorphous foreign materials surrounded by fibroblast-rich young collagenous tissue with giant cells were seen (H & E, ×100) (A). Collagen meshworks of Angioseal were observed (H & E, ×100) (B).

Reference

1. Seok JH, Park YH, Kim MK, et al. Efficacy and complications of Angio-Seal® device in patients undergoing coronary angiography and angioplasty. Korean Circ J. 2003. 33:574–582.

2. Mukhopadhyay K, Puckett MA, Roobottom CA. Efficacy and complications of Angioseal in antegrade puncture. Eur J Radiol. 2005. 56:409–412.

3. Ferreira AC, Eton D, de Marchena E. Late clinical presentation of femoral artery occlusion after deployment of the angio-seal closure device. J Invasive Cardiol. 2002. 14:689–691.

4. Applegate RJ, Rankin KM, Little WC, Kahl FR, Kutcher MA. Restick following initial Angioseal use. Catheter Cardiovasc Interv. 2003. 58:181–184.

5. Ward SR, Casale P, Raymond R, Kussmaul WG 3rd, Simpfendorfer C. Efficacy and safety of a hemostatic puncture closure device with early ambulation after coronary angiography. Am J Cardiol. 1998. 81:569–572.

6. Koreny M, Riedmüller E, Nikfardjam M, Siostrzonek P, Müllner M. Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA. 2004. 291:350–357.

7. Gonze MD, Sternbergh WC 3rd, Salartash K, Money SR. Complications associated with percutaneous closure devices. Am J Surg. 1999. 178:209–211.

8. Gwechenberger M, Katzenschlager R, Heinz G, Gottsauner-Wolf M, Probst P. Use of a collagen plug versus manual compression for sealing arterial puncture site after cardiac catheterization. Angiology. 1997. 48:121–126.

9. Goyen M, Manz S, Kröger K, Massalha K, Haude M, Rudofsky G. Interventional therapy of vascular complications caused by the hemostatic puncture closure device angio-seal. Catheter Cardiovasc Interv. 2000. 49:142–147.