Angio-Seal is a femoral arterial closure device that is commonly used following coronary angiography and angioplasty, to achieve haemostasis at the access site. It is reasonably well tolerated and is proven to improve the time to ambulation. Nonetheless they are associated with certain complications which can cause significant morbidity to the patients unless intervened in time. Here we describe details of complications that we have encountered over the last year, and discuss the evidence base with regard to the use of these devices.

Over the last decade, vascular closure devices (VCD) are increasingly being used following cardiac catheterisation. They are well recognised to reduce the time to haemostasis and time to ambulation thereby reducing the length of hospital stay. Angio-Seal™ (St Jude Medical Minnetonka, USA) is a femoral arterial closure device and consists of a polymer anchor that is deployed intra-arterially, a collagen sponge that is placed on the outer wall of the femoral artery and a self tightening suture. Once the suture is tightened, the anchor and the plug compress the vascular puncture site resulting in haemostasis.

A 57 year old female, who presented to us with complaints of recurrent central chest pain, underwent coronary angiogram through the right femoral artery using 5 Fr Judkins catheters. The puncture site was subsequently closed using an Angio-Seal closure device. Around two weeks following the procedure the patient started experiencing paraesthesia and claudication in her right leg. Clinical examination revealed absent dorsalis pedis and posterior tibial in the affected leg. The patient then underwent a right femoral angiography which showed complete occlusion of the proximal SFA with distal reconstitution.

The patient was then taken for an exploratory surgery. After arteriotomy the distal CFA was found to be occluded by a thrombus which appeared to be attached to the anchor of the Angio-Seal device and the intimal layer of the vessel. She subsequently underwent CFA thrombectomy with vein patch angioplasty. Following the surgery the distal pulses returned and the patient had an uneventful recovery.

A 55 year old diabetic gentleman underwent an elective coronary angioplasty through his right femoral artery following complaints of exertional angina, using 5 Fr Judkins catheters. The vascular puncture site was closed using an Angio-Seal closure device. A week after his discharge the patient presented to the hospital with right groin swelling, fever, chills and rigors. Clinical examination did not reveal any evidence of distal vascular insufficiency.

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ISSN: 2155-9880

Current Issue: Volume 11, Issue 10

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