Balloon Angioplasty for Treatment of Femoral Artery Occlusion following the Use of a Suture- Mediated Closure Device
- Volume 7 - Issue 1 - January 2010
- Posted on: 1/7/10
- 0 Comments
- 11303 reads
Bryan Cogar, MD and Mazan Abu-Fadel, MD, FACC
pg. E31 - E33
Arterial occlusion from the use of suture-mediated closure devices following a percutaneous procedure is a very rare but clinically significant complication for which surgical intervention is thought to be the gold standard for treatment. We present a case of acute femoral artery occlusion following Perclose deployment that was successfully treated with percutaneous balloon angioplasty. Additionally, this report also reviews the current published data on the use of percutaneous intervention following arterial compromise from suture-mediated closure devices.
Key words: Perclose, interventional cardiology; angioplasty, arterial closure device, vascular complications
It is estimated that arterial puncture closure devices are utilized in approximately 50% of patients undergoing a percutaneous coronary procedure.1 The most well described vascular complications of arteriotomy closure devices are pseudoaneurysm, arteriovenous fistula, hematoma, thrombosis, and infection.1,2 One rare, but reported complication has been occlusion of the femoral artery by a suture-mediated closure devices.3–5 In the majority of the reported cases, suture mediated arterial occlusion has been treated with open visualization and surgical correction of the sutured artery. In this report we present a case of acute femoral artery occlusion following deployment of a suture mediated arteriotomy closure device that was treated successfully with balloon angioplasty without the need for surgical exploration and intervention. In addition, we also present a brief review of the current literature on suture mediated complications treated with percutaneous angioplasty. We believe percutaneous treatment performed by skilled operators represents a safe and effective treatment strategy in the acute setting of suture mediated femoral artery occlusion should it occur.
A 64 year-old white male presented to our institution with a diagnosis of left internal carotid artery stenosis. Right femoral artery access was obtained using traditional fluoroscopic guidance and a 6 French (Fr) sheath was used for the procedure. Carotid angiography disclosed a 95% left internal carotid lesion that was successfully stented using an anticoagulation regimen of bivalirudin standard weight0based bolus and a drip. Hemostasis of the right femoral arteriotomy sight was obtained via a Perclose® closure device (Abbott Vascular, Abbott Park, Illlinois). Within 15–20 minutes of completing the procedure, the patient began to complain of right foot numbness. He was then noted on examination to have a mottled right lower extremity with absent peripheral pulses. Bedside ultrasound Doppler examination revealed severe stenosis of the right common femoral artery necessitating emergent transfer back to the catheterization laboratory. Left femoral access was obtained initially with a 7 Fr short-sheath system and a pigtail catheter was placed over the aortic bifurcation in the right external iliac artery. Angiography proved a 95% focal stenosis of the right common femoral artery at the sight of previous arterial access, with very slow flow distal to the occlusion. A 7 Fr Destination sheath (Terumo Medical, Somerset New Jersey) was exchanged to approach the lesion and guide the intervention. The lesion was then successfully crossed with a 0.014 inch coronary wire. A 0.035 inch Quick-Cross catheter (Spectranetics, Inc., Colorado Springs, Colorado) was used to cross the lesion over the 0.014 inch wire. The wire was then exchanged for a long Rosen wire (Infinity Medical, Malibu, California) that was placed in the distal superficial femoral artery (SFA). A 3.0 x 20 mm Fox balloon (Abbott Vascular, Abbott Park, Illinois) was inflated across the lesion to 10 atm. This balloon failed to rupture the suture, thus a 5.0 x 20 mm Fox balloon (Abbott Vascular) was then exchanged and placed across the lesion. Inflation resulted in apparent rupture of the previously placed suture with restoration of femoral blood flow. Final angiography demonstrated no extravasation of contrast outside the common femoral artery and no residual dissection or stenosis within the artery. Clinical follow-up before discharge the next day showed normal peripheral pulses bilaterally and an absence of tenderness, hematomas, or bruits at both the right or left common femoral artery locations.
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