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Difficult Percutaneous Closure of Axillary Access
Esmond Yan Hang Fong1, Angus Shing Fung Chui, Alan Ka Chun Chan
1Division of Cardiology, Queen Elizabeth Hospital, Hong Kong SAR. fongesmond@gmail.com.
The Journal of Invasive Cardiology
|December 8, 2022
Summary
This case study details troubleshooting difficult axillary access closure. Successful hemostasis was achieved through a combination of techniques and device management.
Area of Science:
- Interventional Cardiology
- Vascular Access Management
Background:
- Axillary artery access is crucial for endovascular procedures but can present closure challenges.
- Difficult vascular access closure requires advanced troubleshooting strategies.
Purpose of the Study:
- To illustrate a systematic approach to resolving complications during axillary artery closure.
- To present a novel technique for deploying closure devices in challenging scenarios.
Main Methods:
- Step-by-step troubleshooting of a difficult axillary access closure.
- Utilized balloon-assisted dry closure, escalated wire support, and evaluated various closure devices.
- Employed meticulous device deployment under fluoroscopy, including a novel Angio-Seal delivery in a hydrophilic braided sheath.
Main Results:
- Successful hemostasis was achieved in a complex axillary access closure case.
- Demonstrated the efficacy of a multi-faceted troubleshooting strategy.
- Validated a novel approach for Angio-Seal device delivery.
Conclusions:
- Systematic troubleshooting and understanding device mechanisms are key to managing difficult axillary access closures.
- A novel delivery technique can overcome challenges with specific closure devices in challenging sheath configurations.
- Successful hemostasis in complex cases enhances patient safety and procedural success rates.
