title: Surgical treatment of complications associated with the Angio-Seal vascular closure device.
abstract: Vascular closure devices are used to provide quick hemostasis and early ambulation after percutaneous interventions. The Angio-Seal (AS) vascular closure device forms a mechanical seal by closing the puncture site located between a bioabsorbable anchor within the lumen and a collagen sponge on the adventitia. Although morbidities associated with AS are reportedly infrequent, even the slightest inaccuracy in device implantation may result in displacement of these device components, leading to sudden and severe complications. We report the surgical treatment of complications associated with the use of AS in four patients, including acute limb ischemia, pseudoaneurysm formation, significant hemorrhage, and hypovolemic shock. A common factor in all these cases was that the components of the AS device were displaced from their original site of implantation, stressing the importance of proper device placement. All patients underwent successful surgical vascular repair. Our report highlights the need for exercising extreme care during device implantation, and also the requirement for vigilant inspection for any associated vascular complications commencing immediately after device implantation. It is vital that these device components are actively looked for and removed during surgical exploration so as to prevent future complications.
authors.affiliation: Division of Cardiovascular Surgery, University Hospitals, Geneva, Switzerland. mustafa.cikirikcioglu@hcuge.ch
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cikirikcioglu
authors.forename: Sanjay
authors.initials: S
authors.lastname: Cherian
authors.forename: Vera
authors.initials: V
authors.lastname: Keil
authors.forename: Norman
authors.initials: N
authors.lastname: Manzano
authors.forename: Gino
authors.initials: G
authors.lastname: Gemayel
authors.forename: Thomas
authors.initials: T
authors.lastname: Theologou
authors.forename: Afksendiyos
authors.initials: A
authors.lastname: Kalangos
mesh_terms: D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011677:Punctures; D012769:Shock / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures