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Angiographic follow-up after suture-mediated femoral artery closure
Daniel B Brown1, Steven T Crawford, Patricia L Norton
1Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 South Kingshighway Boulevard, St. Louis, Missouri 63110, USA. brownda@mir.wustl.edu
Insights
Suture-mediated closure with the Perclose device shows minimal long-term effects in patients with normal femoral arteries, even after multiple uses. Follow-up arteriograms revealed few complications, suggesting safety for endovascular procedures.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Device Technology
Background:
- Percutaneous closure devices are frequently used in endovascular procedures, accounting for up to 30% of all cases.
- Limited post-procedure imaging data exists for these commonly used devices.
- Suture-mediated closure, specifically with the Perclose device, warrants further investigation regarding long-term outcomes.
Purpose of the Study:
- To evaluate the long-term effects of suture-mediated closure using the Perclose device.
- To assess outcomes via arteriography in patients who underwent Perclose device closure.
- To determine the safety and efficacy of Perclose device closure in various endovascular scenarios.
Main Methods:
- Retrospective review of arteriograms from 31 patients who underwent Perclose device closure between June 1998 and November 2001.
- Analysis included patients who had Perclose closure after embolization procedures (e.g., hepatic artery chemoembolization) and peripheral vascular disease treatment.
- Assessment of femoral artery caliber and platelet counts in relation to closure outcomes.
Main Results:
- Twenty-eight out of 31 patients (90%) demonstrated normal follow-up arteriograms.
- Patients with normal initial femoral artery caliber and adequate platelet counts showed minimal adverse effects.
- Two patients with atherosclerosis experienced disease progression at the puncture site; one with severe thrombocytopenia developed a pseudoaneurysm.
Conclusions:
- Long-term follow-up suggests minimal adverse effects from Perclose device closure in patients with normal femoral arteries.
- The Perclose device appears safe for repeated use, even in patients with normal arterial anatomy.
- Further studies may be warranted for patients with specific comorbidities like atherosclerosis or severe thrombocytopenia.
Purpose:
Percutaneous closure devices are used in as many as 30% of all endovascular studies. Despite widespread use of these devices, only limited imaging has been performed after percutaneous closure. In this study, arteriograms of patients who had undergone suture-mediated closure with the Perclose device were reviewed.
Materials And Methods:
Between June 1998 and November 2001, 31 patients who had previously undergone closure with use of the Perclose device at our institution returned for additional angiographic procedures. Twenty-one patients underwent closure with use of the Perclose device after embolization, including hepatic artery chemoembolization (n = 18), treatment of hypervascular sacral metastases (n = 2), and bronchial artery embolization (n = 1). Nineteen of these patients had thrombocytopenia. Ten patients underwent closure with use of the Perclose device after diagnosis and treatment of peripheral vascular disease.
Results:
Of 31 patients, 28 had normal follow-up studies, including one patient who underwent four previous closures. These 28 patients all had normal femoral artery caliber at initial angiography and a platelet count of more than 18,000/mm(3). Two patients with preexisting atherosclerotic change had progression of disease at the puncture site and a third with severe thrombocytopenia developed a small asymptomatic posterolateral pseudoaneurysm.
Conclusion:
In patients with normal femoral arteries, the long-term effects of closure with use of the Perclose device, even performed multiple times, appears to be minimal.