Peripheral Vascular Surgery Society

#18 VASCULAR COMPLICATIONS ASSOCIATED WITH ARTERIAL PUNCTURE CLOSURE DEVICES.

James E. Mazo, MD, John Blebea, MD, Marsha M. Neumyer, RVT,Karla M. Anderson, MD, and Robert A. Atnip, MD

Penn State College of Medicine, Hershey, PA

Introduction: Arterial complications following vascular interventional procedures have been well documented. Recently, percutaneous hemostatic puncture closure devices have been introduced to help prevent bleeding, hematomas, and pseudoaneurysms after such interventions. We report several complications resulting from the use of the Angio-Seal™ device.

Patients: Four patients were referred to the Vascular Diagnostic Laboratory for evaluation of acute lower extremity symptoms after cardiac catheterization. Each patient had had an Angio-Seal™ device inserted at the completion of the catheterization procedure. There were three females and one male with a mean age of 67 ± 5 years. Symptoms included large groin hematomas (n=3), new onset of claudication (n=2) and a femoral pulsatile mass. Duplex color-flow examinations were performed to evaluate for potential arterial injuries.

Results: Ultrasound examination documented one femoral pseudoaneurysm for which the patient underwent successful percutaneous ultrasound-guided thrombin injection. Two patients had focal femoral artery stenoses, one involving the common femoral artery while the other occurred in the superficial femoral artery (SFA). Both patients had ankle-brachial indices of 1.0, were observed clinically, and had no further interventions. The last patient was found to have a proximal SFA occlusion with an ABI of 0.73 and unilateral claudication. She refused recommended surgical intervention.

Conclusions: These cases demonstrate some of the possible arterial complications that are associated with failure of the Angio-Seal™ device, despite adherence to the manufacturer's guidelines. Caution must be exercised in their placement and routine use may not be warranted.

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Last updated January 1,2000