Miwa Hiromi, Hayakawa Naoki, Tsuchida Yasuyuki, Ichihara Shinya, Hirano Satoshi, Maruta Shunsuke, Miyaji Kotaro, Kushida Shunichi
Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
CVIR Endovasc. 2024 Oct 5;7(1):72. doi: 10.1186/s42155-024-00487-x.
Hemostatic devices are now frequently used in femoral artery punctures, and the Angio-Seal (Terumo, Tokyo, Japan) is one of the most commonly used devices for closure of the femoral artery because it provides rapid hemostasis. Although device failure rarely occurs, if the collagen falls into the femoral artery, it may lead to severe limb ischemia. Herein, we describe a case of a novel endovascular technique for the treatment of Angio-Seal arterial closure device failure.
The patient in Case 1 was a 75-year-old man with severe left limb claudication. We used a contralateral antegrade approach and used the Angio-Seal for hemostasis. However, the Angio-Seal collagen and footplate dropped and stopped at the bifurcation of the superficial femoral artery and deep femoral artery. The collagen with the footplate was caught with myocardial biotome forceps (MBF) and pulled into the external iliac artery (EIA). The distal common femoral artery (CFA) was punctured, and we delivered a 10.0- × 80-mm stent (SMART; Cordis, USA) to the EIA from the ipsilateral sheath. The stent was deployed at the EIA and crushed the collagen. The patient in Case 2 was an 88-year-old man with rest pain in the right limb. The right CFA was punctured using an ipsilateral approach and the Angio-Seal was used for hemostasis. The Angio-Seal collagen with the footplate dropped into the bifurcation of the deep femoral artery. The collagen and footplate were caught with MBF and pulled up to the EIA. The right CFA was punctured and a 10.0- × 60-mm stent (SMART; Cordis) was delivered from the ipsilateral sheath. The stent was deployed at the EIA and crushed the collagen with the footplate.
MBF were used to grasp the dislodged collagen with the anchor and cover it with a stent at the iliac artery. This may be a useful bailout technique for Angio-Seal dislodgement.
止血装置目前常用于股动脉穿刺，而血管封堵器（日本东京泰尔茂公司生产）是最常用的股动脉闭合装置之一，因为它能实现快速止血。尽管装置故障很少发生，但如果胶原成分落入股动脉，可能会导致严重的肢体缺血。在此，我们描述一例采用新型血管内技术治疗血管封堵器动脉闭合装置故障的病例。
病例1中的患者为一名75岁男性，有严重的左下肢间歇性跛行。我们采用对侧顺行入路并使用血管封堵器进行止血。然而，血管封堵器的胶原成分和脚板掉落并停留在股浅动脉和股深动脉的分叉处。用心肌活检钳（MBF）夹住带有脚板的胶原成分并将其拉入股外动脉（EIA）。穿刺股总动脉远端，然后从同侧鞘管将一个10.0×80毫米的支架（SMART；美国科迪斯公司生产）输送至EIA。该支架在EIA处释放并压碎了胶原成分。病例2中的患者为一名88岁男性，右下肢有静息痛。采用同侧入路穿刺右侧股总动脉，并使用血管封堵器进行止血。带有脚板的血管封堵器胶原成分落入股深动脉分叉处。用MBF夹住胶原成分和脚板并将其向上拉至EIA。穿刺右侧股总动脉，并从同侧鞘管输送一个10.0×60毫米的支架（SMART；科迪斯公司生产）。该支架在EIA处释放并压碎了带有脚板的胶原成分。
使用MBF夹住移位的带有锚定器的胶原成分，并在髂动脉处用支架覆盖它。这可能是一种治疗血管封堵器移位的有效补救技术。
