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Endovascular Management of Common Femoral Artery Occlusion Caused by Suture-mediated Vascular Closure Devices: A
Young Ha Kim1, Lee Hwangbo2, Jun Kyeung Ko1
1Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Insights
Suture-mediated vascular closure devices (VCDs) can cause rare common femoral artery (CFA) occlusions. Endovascular treatment, including angioplasty and stenting, proved effective in managing these occlusions, offering a viable alternative to surgery.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Vascular closure devices (VCDs) are widely used for femoral artery hemostasis.
- Suture-mediated VCDs can lead to rare but serious complications like common femoral artery (CFA) occlusion.
- Optimal management strategies for VCD-induced CFA occlusion are not well-established, with surgery traditionally favored.
Purpose of the Study:
- To report clinical experience managing CFA occlusions caused by suture-mediated VCDs.
- To introduce and evaluate an endovascular treatment strategy for this complication.
- To assess the feasibility and efficacy of endovascular management versus open surgery.
Main Methods:
- Retrospective review of 6 cases of CFA occlusion following suture-mediated VCD use over 10 years.
- All patients were treated with an endovascular approach.
- The endovascular strategy involved balloon angioplasty, with stenting for residual stenosis >50%.
Main Results:
- Endovascular treatment was technically successful in all 6 cases with no major complications.
- Mean stenosis pre-intervention was 91.9%; 3 cases had long segmental occlusion.
- Post-intervention residual stenosis averaged 25.1%, with 4 cases treated by angioplasty alone and 2 requiring stenting.
- Mean follow-up of 37.8 months showed no recurrent ischemia symptoms.
Conclusions:
- Endovascular management is a feasible and effective first-line treatment for CFA occlusion secondary to suture-mediated VCDs.
- Timely diagnosis and intervention are crucial for successful outcomes.
- Adjunctive stenting may be necessary for complex occlusions or significant residual stenosis post-angioplasty.
Abstract:
ObjectiveVascular closure devices (VCDs) are frequently employed to achieve hemostasis at the femoral puncture site, offering an alternative to traditional manual compression. However, a rare yet significant complication is common femoral artery (CFA) occlusion caused by suture-mediated VCDs. The optimal management of this complication remains unclear, with open surgical repair traditionally regarded as the standard of care. This paper aims to share our clinical experience in managing CFA occlusions caused by suture-mediated VCDs and to introduce our preferred endovascular treatment strategy.MethodsAt our institution, approximately 250 femoral artery hemostasis procedures using suture-mediated VCDs are performed annually. Over the past 10 years, we encountered 6 cases of CFA occlusion following the use of such devices. This corresponds to an incidence rate of approximately 0.24%. In all cases, endovascular management was selected as the primary treatment modality over open surgical intervention. Our endovascular approach consisted of initial balloon angioplasty, with adjunctive stenting performed when residual stenosis exceeded 50%.ResultsEndovascular treatment was technically successful in all 6 cases, with no major procedural complications. The mean degree of stenosis prior to balloon angioplasty was 91.9%, including 3 cases of long segmental occlusion. Balloon angioplasty alone was sufficient in 4 cases, while the remaining 2 required additional stenting to address significant residual stenosis. Final angiography demonstrated an average residual stenosis of 25.1%. During the follow-up period (mean duration: 37.8 months), no patients reported symptoms of lower extremity ischemia.ConclusionThis case series highlights the feasibility and efficacy of endovascular management as a first-line approach for CFA occlusion caused by suture-mediated VCDs. When diagnosis is delayed, long segmental occlusion with considerable thrombus burden may limit the effectiveness of balloon angioplasty alone, necessitating adjunctive stenting. Therefore, timely diagnosis and intervention are essential to optimize outcomes in these cases.
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