Implementation of the EXOSEAL Vascular Closure Device in the Transpopliteal Arterial Approach

To investigate the feasibility and safety of the EXOSEAL vascular closure device (VCD) in achieving hemostasis in transpopliteal arterial interventions.

Between May 2014 and May 2016, 46 procedures involving transpopliteal arterial access in 28 patients (18 bilateral and 10 unilateral) were analyzed retrospectively. Popliteal arterial puncture was performed under ultrasonographic (US) and fluoroscopic guidance by using a micropuncture access set with a 21-gauge needle. Six-French sheaths were used in 45 procedures, and a 7-F sheath was used in 1 procedure. Hemostasis was achieved with the EXOSEAL VCD. All patients were examined for any access-related complications with US at 6 and 24 hours after the procedure. One week later, all patients were followed up in the outpatient clinic.

In 44 of the 46 procedures, the EXOSEAL VCD was applied successfully. The technical failure rate was 4.4%. An excessively steep angle of the introducer sheath and improper placement of the EXOSEAL plug in the setting of high blood pressure (220/120 mm Hg) were the reasons for the 2 failures. Among the 44 successful procedures, 1 (2.3%) minor 3-cm hematoma was found to be associated with the VCD. In 1 of the 46 procedures, an arteriovenous fistula (2.2%) was observed as a puncture-related complication and treated with a stent graft.

The EXOSEAL VCD can be safely used for hemostasis in interventions that use transpopliteal arterial approaches, with a high technical success rate and a low rate of entry-site complications.