Histologic and duplex comparison of the perclose and angio-seal percutaneous closure devices.
The intravascular and extravascular effects of percutaneous closure devices have not been well studied. We assessed the performance and healing characteristics in dogs of two devices approved by the US Food and Drug Administration. Nine adult male dogs were anesthesized prior to percutaneous access of both femoral arteries with a 6F sheath. All dogs were systemically heparinized to an activated clotting time (ACT) > 250 seconds. Duplex sonography was performed preoperatively to measure vessel diameter and flow velocity. In each dog, one of two devices (Perclose, Abbot Laboratories, Abbott Park, IL or Angio-Seal, St. Jude Medical, St. Paul, MN) was randomly deployed into one of the two femoral arteries. The other device was deployed on the opposite side. Duplex sonography was repeated immediately after deployment and 28 days later to measure changes in vessel diameter and flow velocity. At 28 days, angiography was performed on both femoral arteries before they were removed for histologic evaluation. The time required to excise each vessel reflected the degree of scarring. Hemostasis time for the Angio-Seal device far surpassed the Perclose device (39 +/- 7 vs 0 minutes; p < .05). Vessel narrowing was observed only at 28 days after deployment of the Angio-Seal device (p < .05). Extensive extravascular scarring was observed with the Angio-Seal device, which resulted in a longer femoral artery dissection time and greater periadventitial scar thickness compared with the Perclose device (p < .05). When compared with the Perclose suture closure device, the Angio-Seal collagen plug closure device prolonged hemostasis time and produced greater vessel narrowing and periadventitial inflammation (extravascular scarring) in a canine model at 4 weeks.
Gargiulo
Nicholas J
NJ
Division of Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 20th Street, Bronx, NY 10467, USA. ngargiul@montefiore.org
Veith
Frank J
FJ
Ohki
Takao
T
Scher
Lawrence A
LA
Berdejo
George L
GL
Lipsitz
Evan C
EC
Menegus
Mark
M
Greenberg
Mark
M
D000818:Animals; D002921:Cicatrix / Q000473:pathology; D004285:Dogs; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D006965:Hyperplasia / Q000473:pathology; D008297:Male; D023421:Models, Animal; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods; D014945:Wound Healing / Q000502:physiology