Surgical treatment of arterial ischemia associated with the use of the angioseal vascular closure device

Despite the theoretical effectiveness of the Angio-Seal closure device to control bleeding after arterial puncture it can increase the risk of ischemia. To describe arterial lesions caused by the device, surgical techniques needed to repair those lesions and surgical outcome in patients who underwen...

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Bibliographic Details
Published in:	VASA Vol. 38; no. 4; p. 334
Main Authors:	Pontón, A, Negueruela, C P, Bernal, J M, García, I, Arnáiz, E, Solórzano, L D, Revuelta, J M
Format:	Journal Article
Language:	English
Published:	Switzerland 01-11-2009
Subjects:	Aged Aged, 80 and over Angioplasty Blood Vessel Prosthesis Implantation Cardiac Catheterization - adverse effects Endarterectomy Equipment Design Female Femoral Artery - surgery Hemorrhage - etiology Hemorrhage - prevention & control Hemostatic Techniques - adverse effects Hemostatic Techniques - instrumentation Humans Ischemia - etiology Ischemia - surgery Lower Extremity - blood supply Male Middle Aged Punctures Thrombectomy Thrombosis - etiology Thrombosis - surgery Time Factors Treatment Outcome Vascular Surgical Procedures
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Summary:	Despite the theoretical effectiveness of the Angio-Seal closure device to control bleeding after arterial puncture it can increase the risk of ischemia. To describe arterial lesions caused by the device, surgical techniques needed to repair those lesions and surgical outcome in patients who underwent surgery for arterial ischemia after heart catheterization. Seven patients underwent surgery over a period of 12 months at our institution. Five patients underwent emergency surgery and two a delayed procedure. The cause of ischemia was dissection of an atheroma plaque at the puncture site in four cases, dissection of the superficial femoral artery in one case, thrombosis of the common femoral artery in one case, and plication of the posterior arterial wall in one case. Arterial repair in these patients required the insertion of a vascular graft in three cases, endarterectomy plus angioplasty in two cases, endarterectomy plus graft interposition plus thrombectomy of the superficial femoral artery in one case and endarterectomy plus femoropopliteal bypass in one case. Treatment was successful in all patients. Mean follow up was 7.6 months (range 5-11 months). During the study period one patient died due to cardiopathy. No patients had to be re-operated and no limb losses were recorded. All the patients were asymptomatic from a vascular point of view with normal active lives for their age. Surgical repair is effective, although, generally, it is not restricted to a simple thrombectomy, requiring the use of different arterial repair techniques.
ISSN:	0301-1526
DOI:	10.1024/0301-1526.38.4.334