title: Surgical treatment of arterial ischemia associated with the use of the angioseal vascular closure device.
abstract: BACKGROUND
  Despite the theoretical effectiveness of the Angio-Seal closure device to control bleeding after arterial puncture it can increase the risk of ischemia.
  
  
  OBJECTIVE
  To describe arterial lesions caused by the device, surgical techniques needed to repair those lesions and surgical outcome in patients who underwent surgery for arterial ischemia after heart catheterization.
  
  
  METHODS
  Seven patients underwent surgery over a period of 12 months at our institution. Five patients underwent emergency surgery and two a delayed procedure. The cause of ischemia was dissection of an atheroma plaque at the puncture site in four cases, dissection of the superficial femoral artery in one case, thrombosis of the common femoral artery in one case, and plication of the posterior arterial wall in one case. Arterial repair in these patients required the insertion of a vascular graft in three cases, endarterectomy plus angioplasty in two cases, endarterectomy plus graft interposition plus thrombectomy of the superficial femoral artery in one case and endarterectomy plus femoropopliteal bypass in one case.
  
  
  RESULTS
  Treatment was successful in all patients. Mean follow up was 7.6 months (range 5-11 months). During the study period one patient died due to cardiopathy. No patients had to be re-operated and no limb losses were recorded. All the patients were asymptomatic from a vascular point of view with normal active lives for their age.
  
  
  CONCLUSIONS
  Surgical repair is effective, although, generally, it is not restricted to a simple thrombectomy, requiring the use of different arterial repair techniques.
authors.affiliation: Hospital Universitario Marqués de Valdecilla, Santander, Spain. aponton@comcantabria.es
authors.forename: A
authors.initials: A
authors.lastname: Pontón
authors.forename: C P
authors.initials: CP
authors.lastname: Negueruela
authors.forename: J M
authors.initials: JM
authors.lastname: Bernal
authors.forename: I
authors.initials: I
authors.lastname: García
authors.forename: E
authors.initials: E
authors.lastname: Arnáiz
authors.forename: L D
authors.initials: LD
authors.lastname: Solórzano
authors.forename: J M
authors.initials: JM
authors.lastname: Revuelta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization / Q000009:adverse effects*; D004691:Endarterectomy; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011677:Punctures; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures