Safety and efficacy of a circumferential clip-based vascular closure device in cirrhotic and coagulopathic patients with hepatocellular carcinoma after doxorubicin drug-eluting beads transarterial chemoembolization.
OBJECTIVE
This study was designed to investigate the safety and efficacy of the circumferential clip-based (StarClose) vascular closure device (VCD) in coagulopathic and cirrhotic patients with hepatocellular carcinoma (HCC) after doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE).


METHODS
Consecutive cirrhotic patients with HCC, who underwent DEB TACE from November 2009 to February 2012, were included in the study. Based on platelet count (PC) and international normalized ratio (INR), these patients were further divided into group A (PC ≥ 150 k/dl), B (PC = 50-149 k/dl), C (PC < 50 k/dl), D (INR ≤ 1.2), E (INR = 1.21-1.5), and F (INR > 1.5). StarClose VCD was attempted in each case. Technical success was defined as complete hemostasis achieved within 3 min after the closure. Periprocedural complications were studied.


RESULTS
A total of 350 DEB TACEs were performed in 195 patients (mean age 61.6 years, SD 9.1). StarClose VCD was attempted in all cases. StarClose device was not deployed in 2.2 % (8/350) of cases due to improper femoral punctures and severe atherosclerotic disease. Technical success rate was 97.1 % (332/342). All groups (A-F) were similar in age, sex, body mass index, and technical success rate (P > 0.05). Minor complications occurred after 1.8 % (6/342) of cases. VCD was repeatedly used in 92 patients with 96.2 % (230/239) of technical success rate. There was no major complication related to VCD. There was no access site infection, leg ischemia, and pseudoaneurysm or symptomatic groin hematoma.


CONCLUSIONS
Circumferential clip based (StarClose) arterial closure device achieved effective and rapid hemostasis after DEB TACE with minimal complications in cirrhotic patients with HCC and coagulopathy. StarClose deployment and reaccess in patients with PC < 50 k/dl and INR > 1.2 are safe and effective.
Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology, Winship Cancer Institute, Emory University School of Medicine, 1364 Clifton Road NE, Suite AG-05, Atlanta, GA, 30322, USA, hasmukhjpr@hotmail.com.
Hasmukh J
HJ
Prajapati
Shoaib
S
Rafi
Faramarz
F
Edalat
David A
DA
Kooby
Hyun S
HS
Kim
D001706:Biopsy; D001780:Blood Coagulation Tests; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures; D016896:Treatment Outcome; D065506:Vascular Closure Devices
D004317:Doxorubicin