Percutaneous endovascular management of Angio‐Seal related vascular occlusion

• Published in: Catheterization and cardiovascular interventions 2024-12, Vol.104 (7), p.1461-1468
• Main Authors: Haberman, Dan, Czulada, Evan, Lupu, Lior, Chitturi, Kalyan R., Chaturvedi, Abhishek, Abusnina, Waiel, Merdler, Ilan, Reddy, Pavan, Ben‐Dor, Itsik, Satler, Lowell F., Waksman, Ron, Bernardo, Nelson L.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angioplasty; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Angio‐Seal; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - therapy; atherectomy; Atherectomy - adverse effects; Balloon treatment; Cardiovascular system; Catheterization, Peripheral - adverse effects; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Equipment Design; Female; Femoral artery; Femoral Artery - diagnostic imaging; femoral artery occlusion; Femur; Hemorrhage - etiology; Hemostasis; Hemostatic Techniques - adverse effects; Hemostatic Techniques - instrumentation; Humans; Male; Middle Aged; Occlusion; Patients; percutaneous endovascular intervention; Punctures; Retrospective Studies; Risk Factors; Stents; Time Factors; Treatment Outcome; vascular closure device; Vascular Closure Devices; Veins & arteries
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.31272

Background The use of vascular closure devices (VCDs) to achieve quick and safe hemostasis after femoral arterial access is widely accepted. Major complications include bleeding and occlusion of the femoral artery due to device failure, which often necessitates vascular intervention. This manuscript details our peripheral percutaneous endovascular interventional (PEI) approach for the management of femoral artery occlusion resulting from Angio‐Seal (Terumo, Somerset, New Jersey, USA) VCD deployment. Methods Consecutive patients who developed occlusive complications after Angio‐Seal deployment underwent PEI to overcome specific complications. Patients’ clinical and procedural characteristics, along with their short‐ and long‐term follow‐up data, were analyzed. Results The study cohort included 40 patients who experienced Angio‐Seal occlusive complications between July 2013 and September 2023. The mean age of the patients was 74 ± 10 years and 55% were female. All the patients were treated with PEI, with an overall procedural success rate of 100%. The primary approach for PEI was directional atherectomy, which was used in 35 cases (88%), followed by balloon, while a cutting balloon was used in 5 patients (13%). Stenting served as the definitive therapy in only 7 patients (18%). No procedural complications or conversions to surgery were observed. During a median follow‐up of 244 (IQR = 100–707) days, none of the patients required re‐intervention related to Angio‐Seal occlusion and salvage intervention. Conclusion In the management of Angi‐Seal VCD‐related femoral artery occlusion, the adjunctive use of directional atherectomy followed by balloon angioplasty was effective and safe, allowing re‐establishment of flow with excellent long‐term outcomes.