Trans-Sheath Thrombin Injection to Achieve Hemostasis During Increased Bore Retrograde Accesses.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Interventions

Background:

• Retrograde popliteal and below-the-knee (BTK) arterial access are crucial for complex endovascular procedures.
• Achieving reliable hemostasis, especially with larger sheath sizes (≥ 5F), can be challenging.
• Access site complications can limit the utility of these retrograde approaches.

Purpose of the Study:

• To describe a novel technique for achieving reliable hemostasis after retrograde popliteal or proximal BTK arterial access.
• To evaluate the safety and efficacy of trans-sheath injection of a hemostatic matrix with thrombin for sealing percutaneous tracts.
• To address the challenges of hemostasis in larger-profile endovascular interventions.

Main Methods:

• A guidewire is advanced across the retrograde puncture site from antegrade femoral access.
• A balloon catheter is positioned, and the retrograde sheath is withdrawn under aspiration until extraluminal.
• Hemostatic matrix with thrombin is injected through the sheath lumen to occlude the tract, followed by angiography to confirm hemostasis.

Main Results:

• The technique was applied in 21 consecutive cases (15 popliteal, 6 BTK) with access site ≥ 5F.
• Primary technical success was high at 95.2% (20/21), with one case requiring additional compression.
• No secondary complications such as pseudoaneurysm, thrombosis, infection, or distal embolization were observed during 30-day follow-up.

Conclusions:

• Trans-sheath delivery of hemostatic matrix with thrombin is a feasible, safe, and reproducible closure strategy.
• This technique offers effective hemostasis for increased-bore retrograde popliteal or proximal BTK accesses.
• It minimizes access-site complications and may expand the safe use of retrograde access in complex peripheral interventions.