Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
Vasc Endovascular Surg. 2023 Oct;57(7):795-800. doi: 10.1177/15385744231173200. Epub 2023 Apr 25.
Vascular closure devices (VCDs) are widely used to achieve rapid hemostasis after percutaneous intervention via the common femoral artery (CFA), with well-established efficacy and safety. Although VCD-related artery occlusion is rare, it can be critical. A 72-year-old female underwent endovascular therapy (EVT) for stent occlusion in the left superficial femoral artery through a 7-Fr guiding sheath from the right CFA. After the procedure, an acute right popliteal artery (POP-A) occlusion, associated with the EXOSEAL VCD plug, occurred. The plug material was successfully removed using a bidirectional approach. The migration plug was blocked to prevent distal vessel migration and pushed gently to close the antegrade system, using an over-the-wire balloon from the retrograde site. We named this the "Push balloon INto vessel and Close Embolus from Retrograde site" (PINCER) technique. Finally, the plug was successfully removed using biopsy forceps. Acute limb ischemia (ALI) caused by EXOSEAL is a rare condition. Removal of the emboli by EVT is clinically significant because it is minimally invasive. However, it is sometimes difficult to remove the embolus using only antegrade approach; thus, the bidirectional approach using the PINCER technique can be effective in these situations.
血管闭合装置（VCD）广泛用于经股动脉（CFA）进行经皮介入后实现快速止血，具有良好的疗效和安全性。尽管与 VCD 相关的动脉闭塞很少见，但却可能很关键。一名 72 岁女性因左股浅动脉支架阻塞而行血管内治疗（EVT），采用 7Fr 引导鞘从右侧 CFA 进入。手术后，出现了急性右腘动脉（POP-A）闭塞，与 EXOSEAL VCD 塞栓相关。使用双向方法成功取出了塞栓材料。使用超硬导丝球囊从逆行部位双向进入，以阻塞迁移塞栓防止远端血管迁移，并轻轻推动以关闭顺行系统。我们将这种技术命名为“Push balloon INto vessel and Close Embolus from Retrograde site”（PINCER）技术。最后，使用活检钳成功取出了塞栓。EXOSEAL 导致的急性肢体缺血（ALI）是一种罕见的情况。EVT 取栓具有重要的临床意义，因为它是微创的。然而，有时仅采用顺行方法很难取出栓子；因此，在这种情况下，使用 PINCER 技术的双向方法可能是有效的。
