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Updated: Jun 23, 2026

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Published on: December 23, 2022

Re-access complication with a Starclose device.

Rekhi Varghese¹, David Chess, David Lasorda

¹Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA. rvarghes@wpahs.org

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions

|May 21, 2009

Summary

This summary is machine-generated.

Repetitive femoral artery access through a nitinol clip closure device can lead to catheter entrapment. This case highlights potential risks associated with re-accessing previously closed arteriotomies, necessitating surgical intervention for device removal.

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Area of Science:

Cardiovascular Interventions
Medical Device Safety
Vascular Surgery

Background:

Percutaneous closure devices, such as the nitinol clip Starclose, are widely used after diagnostic cardiac catheterizations via femoral artery access to enhance patient comfort and mobility.
The safety of re-puncturing an artery previously sealed with a closure device has not been extensively studied in human subjects.
Previous studies, like the Clip Closure In Percutaneous Procedures (CLIP) study, supported the use of nitinol clip devices.

Observation:

A patient who underwent cardiac surgery required post-operative monitoring via an arterial line.
The arterial line was placed at the site of a prior femoral arteriotomy, which had been closed using the Starclose nitinol clip device.
During placement, the catheter advanced through the center of the nitinol clip and became tethered to its periphery.

Findings:

The catheter could not be removed using standard techniques due to entanglement with the nitinol clip.
Surgical intervention was ultimately required to extract the catheter and the adhered device.
This case demonstrates a potential complication of re-accessing a vessel closed with a nitinol clip device.

Implications:

Clinicians should exercise caution when considering repeat arterial access at sites previously treated with nitinol clip closure devices.
Further research is warranted to establish guidelines for safe re-accessing of vessels closed with percutaneous devices.
This event underscores the importance of considering the long-term behavior and potential complications of vascular closure devices.