title: Obesity: an independent risk factor for insufficient hemostasis using the AngioSeal vascular closure device after antegrade puncture.
abstract: OBJECTIVE
  This study was designed to investigate the efficacy of the AngioSeal vascular closure device after antegrade puncture of the femoral artery.
  
  
  METHODS
  In a prospective study, 120 consecutive patients underwent lower limb vascular intervention by an antegrade access to the common femoral artery (CFA). After intervention, a 6F (n = 88) or an 8F (n = 32) AngioSeal vascular closure device was used to achieve hemostasis. The technical success or the cause of failure was documented. In addition, the coagulation status (platelets, INR, prothrombin time, atrial thromboplastin time (PTT)), hypertonus, locoregional habitus of the groin, body mass index (BMI), presence of calcifications, and history of previous surgical interventions of the CFA were evaluated.
  
  
  RESULTS
  Hemostasis was achieved in 97 patients (81%). In 12 patients (10%), persistent bleeding of the puncture site required manual compression. In another nine patients (8%) a kink of the sheath obviated the passage of the collagen plug toward the vessel, and in two patients the anchor dislodged out of the vessel, requiring manual compression. There were no significant differences between the groups of successful and unsuccessful sealing regarding the mean platelets (241 vs. 254 * 10(9)/l; P = 0.86), INR (1.06 vs. 1.02; P = 0.52), prothrombin time (90% vs. 90%; P = 0.86), and PTT (30 vs. 31 s; P = 0.82). However, unsuccessful sealing was more likely in obese patients with an increased BMI (26.6 vs. 28.8 kg/m(2); P = 0.04).
  
  
  CONCLUSIONS
  Obesity seems to be an independent risk factor for insufficient sealing using the AngioSeal vascular closure device after antegrade puncture of the CFA. In 8% of our patients, hemostasis could not be achieved due to kink of the flexible sheath.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Saarland, Homburg/Saar, Germany. peterminko@yahoo.com
authors.forename: Peter
authors.initials: P
authors.lastname: Minko
authors.forename: Marcus
authors.initials: M
authors.lastname: Katoh
authors.forename: Stefan
authors.initials: S
authors.lastname: Gräber
authors.forename: Arno
authors.initials: A
authors.lastname: Buecker
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D009765:Obesity / Q000150:complications*; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D011446:Prospective Studies; D011677:Punctures; D015641:Radiography, Interventional / Q000295:instrumentation; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome