Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#13. INCIDENCE AND TREATMENT OF INFECTION COMPLICATIONS RELATED TO HEMOSTATIC PUNCTURE CLOSURE DEVICES
Swee Lian Tan, MD, PhD Parkland Medical Center Derry, NH
Vessel puncture occluders are currently being marketed as a way to shorten observation times after cardiac catheterization procedures. Most of these devices are deployed external to the artery, but at least one device, Angio-Seal (Sherwood Davis & Geck), includes a polymer anchor that is deployed inside the artery. More than 80,000 Angio-Seal devices have been sold.
The manufacturer of Angio-Seal presents studies that show a reduction in mean time to ambulation from 6.6 to 1.4 hours. Much less discussed are the complications that may arise from the use of this device, such as thrombosis, embolization of the anchor, and infection. The manufacturer makes no claim and randomized trials do not indicate that Angio-Seal reduces the rate of complications compared to manual compression.
We present a case involving infection of the groin, in which the patient presented with septic shock and renal failure after cardiac catheterization. A large abscess was present, and removal of the device required arterial surgery in an infected field. The exploratation was performed as if there had been an infected graft. Embolization was prevented by outflow occlusion prior to dissection near the puncture site.
Because the intended use of the Angio-Seal and similar devices is to reduce the time to ambulation and hence for observation, it is unlikely that symptoms of infection will appear prior to discharge. Patients and emergency departments may not be aware of the significance of these symptoms, leading to the more advanced infection reported here. Given the importance of meticulously sterile conditions when using these devices, the use of preoperative antibiotics should be considered.
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Last updated January 10, 1999