Angio-Seal Vascular Closure Related Acute Limb Ischemia: A Case Report

Maya Srinivasan¹, Pramod Theetha Kariyanna¹, Jeremy Smith¹, Sushruth Das², Amog Jayarangaiah³, Sudhanva Hegde¹, Jessica L. Perez Perez¹ and Isabel M. McFarlane^1,

¹Division of Cardiovascular Diseases and Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, U.S.A.

²Base PU College, Rajajinagar, Bangalore, India- 560010.

³Trinity School of Medicine, Ratho Mill, Ribishi, St. Vincent and Grenadines

Cite this paper:
Maya Srinivasan, Pramod Theetha Kariyanna, Jeremy Smith, Sushruth Das, Amog Jayarangaiah, Sudhanva Hegde, Jessica L. Perez Perez and Isabel M. McFarlane. Angio-Seal Vascular Closure Related Acute Limb Ischemia: A Case Report. American Journal of Medical Case Reports. 2020; 8(2):49-52. doi: 10.12691/ajmcr-8-2-3

Abstract

Vascular Closure Devices (VCD) are routinely used in cardiac catheterization and other endovascular procedures in order to achieve immediate post-procedural hemostasis and sealing of the femoral artery puncture site. Unlike manual compression, VCD encompass a broad range of devices, with varying mechanisms, that offer the advantage of achieving rapid hemostasis, increased patient comfort and mobility, decreased reliance on hospital staff resources, and facilitate earlier hospital discharge. Complications of VCD have been well-described and include embolization, arterial occlusion, infection, or vascular obstruction. Here, we describe a case in which the Angio-Seal device was utilized during an elective cardiac catheterization resulted in acute lower extremity ischemia.

Keywords:
vascular closure devices percutaneous coronary intervention angio-seal device embolization vascular obstruction

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References:

[1]	Noori VJ, Eldrup-Jørgensen J. A systematic review of vascular closure devices for femoral artery puncture sites. Journal of Vascular Surgery. 2018; 68(3): 887-899.
[2]	Kwok CS, Khan MA, Rao SV, et al. Access and non-access site bleeding after percutaneous coronary intervention and risk of subsequent mortality and major adverse cardiovascular events: systematic review and meta-analysis. Circ Cardiovasc Interv. 2015; 8(4).
[3]	Robertson L, Andras A, Colgan F, et al. Vascular closure devices for femoral arterial puncture site haemostasis. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD009541.
[4]	Nikolsky E, Mehran R, Halkin A, et al. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol. 2004;44(6): 1200.
[5]	Resnic F, Arora N, Matheny M, et al. A cost-minimization analysis of the angio-seal vascular closure device following percutaneous coronary intervention. Am J Cardiol. 2007; 99(6): 766-770.
[6]	Schulz-Schüpke S, Helde S, Gewalt S, et al. Comparison of Vascular Closure Devices vs Manual Compression After Femoral Artery Puncture: The ISAR-CLOSURE Randomized Clinical Trial. JAMA. 2014; 312(19): 1981-1987.
[7]	Marso S, Amin A, House J, et al. Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. JAMA, 2010; 303(21).
[8]	Khaldi A, Waldau B, Skowlund C, et al. Delayed Complication from a Percutaneous Vascular Closure Device Following a Neuro-Interventional Procedure. Interv Neuroradiol. 2011; 17(4): 495-500.
[9]	Cox T, Blair L, Huntington C, et al. Systematic Review of Randomized Controlled Trials Comparing Manual Compression to Vascular Closure Devices for Diagnostic and Therapeutic Arterial Procedures. Surg Technol Int. 2015; 27: 32-44.
[10]	Applegate, R., Sacrinty, M., Kutcher, M. et al. Trends in vascular complications after diagnostic cardiac catheterization and percutaneous coronary intervention via the femoral artery, 1998 to 2007. JACC. Cardiovascular Interventions, 1(3), 317-326.
[11]	Vidi VD, Matheny ME, Govindarajulu US, et al. Vascular closure device failure in contemporary practice. JACC Cardiovasc Interv. 2012; 5(8): 837-844.
[12]	Theodos G, Raymond C, Becker MC, et al. Arteriotomy closure device safety after percutaneous coronary intervention in the direct thrombin inhibitor era: a comparative study. Catheter Cardiovasc Interv. 2013; 81(2): 294-300.
[13]	Biancari F, D’Andrea V, Di Marco C, et al. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 2010; 159(4): 518-531.
[14]	Koreny M, Riedmüller E, Nikfardjam M, et al. Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA. 2004 Jan 21; 291(3): 350-7.
[15]	Bangalore S, Arora N, and Resnic F. Vascular Closure Device Failure: Frequency and Implications. A Propensity-Matched Analysis. Published October 27th 2009. Circulation: Cardiovascular Interventions. 2009; 2: 549-556.
[16]	Wille J, Vos JA, Overtoom TT, et al. Acute leg ischemia: the dark side of a percutaneous femoral artery closure device. Ann Vasc Surg. 2006; 20(2): 278-281.
[17]	Abando A, Hood D, Weaver F, et al. The use of the Angioseal device for femoral artery closure. J Vasc Surg. 2004; 40(2): 287-290.
[18]	Kalapatapu VR, Ali AT, Masroor F, et al. Techniques for managing complications of arterial closure devices. Vasc Endovascular Surg. 2006; 40(5): 399-408.
[19]	Romagnoli E, Biondi-Zoccai G, Sciahbasi A, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012; 60(24): 2481-2489.
[20]	Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775): 1409-1420.