title: Management of acute lower limb ischemia associated with the Angio-Seal arterial puncture closing device.
abstract: Arterial percutaneous closure devices (APCD) could lead to severe vascular complications, like acute lower limb ischemia. The aim of this study was to evaluate retrospectively our personal series of acute lower limb ischemia following the use of APCD. From January 2004 to June 2009 the Angio-Seal percutaneous closure devices was deployed in 198 patients. Eight (4%) acute lower limb ischemia required urgent surgical repair. The device was removed in all cases. A thromboembolectomy was performed in five patients (62.5%) and in three (37.5%) an endarterectomy with patch closure was carried out (two saphenous vein and one Dacron). Limb salvage rate was 87.5%. We compared Angio-Seal complications group (A) with the 190 patients in which the Angio-Seal was successfully used without complications (group B) by means of Student's t-test. At 36-month follow-up with color-coded duplex ultrasounds, no chronic limb ischemia or other complications requiring surgical repair occurred. Diabetes, obesity, severe femoral atherosclerotic involvement, use of sheath size >7 Fr and time-consuming procedures were significant risk factors for ischemic APCD complications. Despite vascular injuries being uncommon after APCD deployment, generally a complex surgical repair is necessary. A more careful patient selection would be advisable.
authors.affiliation: Vascular and Endovascular Surgery Unit, ASL RMF 'San Paolo' Hospital, Largo Donatori di Sangue, Civitavecchia, 00053 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Siani
authors.forename: Federico
authors.initials: F
authors.lastname: Accrocca
authors.forename: Roberto
authors.initials: R
authors.lastname: Gabrielli
authors.forename: Roberto
authors.initials: R
authors.lastname: Antonelli
authors.forename: Alessandro G
authors.initials: AG
authors.lastname: Giordano
authors.forename: Cesare
authors.initials: C
authors.lastname: Ambrogi
authors.forename: Giustino
authors.initials: G
authors.lastname: Marcucci
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D020878:Device Removal; D017128:Embolectomy; D004691:Endarterectomy; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007558:Italy; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011677:Punctures; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017131:Thrombectomy; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014656:Vascular Surgical Procedures