Urata Ryota, Nomura Tetsuya, Hori Yusuke, Yoshioka Kenichi, Kubota Hiroshi, Miyawaki Daisuke, Sugimoto Takeshi, Kikai Masakazu, Keira Natsuya, Tatsumi Tetsuya
Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, Yagi-cho, Nantan, Japan.
J Med Case Rep. 2019 Mar 21;13(1):90. doi: 10.1186/s13256-018-1950-2.
Vascular closure devices have been widely used to achieve rapid hemostasis after percutaneous catheterization procedures via the common femoral artery. The EXOSEAL vascular closure device is a device that can deliver a bioabsorbable polyglycolic acid plug to fill the subcutaneous puncture route at the groin for rapid hemostasis, and this device has a lower risk of arterial occlusion than other vascular closure devices.
An 83-year-old Japanese man underwent percutaneous coronary intervention for a proximal stenosis in his left circumflex artery through a 7-Fr sheath from his right common femoral artery. We encountered acute popliteal artery occlusion associated with EXOSEAL vascular closure device. We detected the plug material of this device at the occluded lesion by intravascular ultrasound, and performed successful bailout stenting after pulling the embolus with an inflated balloon catheter up to the superficial femoral artery from the popliteal artery.
Acute limb ischemia caused by an EXOSEAL vascular closure device is a very rare complication. Balloon angioplasty and stenting are considered to be effective options to deal with the plug dislodgement of an EXOSEAL vascular closure device. We must be prepared for every rare complication during endovascular treatment.
血管闭合装置已被广泛用于经股总动脉进行经皮导管插入术后实现快速止血。EXOSEAL血管闭合装置是一种能够输送可生物吸收的聚乙醇酸栓子以填充腹股沟处皮下穿刺路径从而实现快速止血的装置，并且该装置与其他血管闭合装置相比，发生动脉闭塞的风险更低。
一名83岁的日本男性通过右股总动脉的7F鞘管对其左旋支动脉近端狭窄进行经皮冠状动脉介入治疗。我们遇到了与EXOSEAL血管闭合装置相关的急性腘动脉闭塞。我们通过血管内超声在闭塞病变处检测到该装置的栓子材料，并在用球囊导管将栓子从腘动脉向上拉至股浅动脉后成功进行了补救性支架置入术。
EXOSEAL血管闭合装置引起的急性肢体缺血是一种非常罕见的并发症。球囊血管成形术和支架置入术被认为是处理EXOSEAL血管闭合装置栓子移位的有效选择。在血管内治疗期间，我们必须为每一种罕见并发症做好准备。
