title: The Use of ExoSeal Vascular Closure Device for Direct Antegrade Superficial Femoral Artery Puncture Site Hemostasis.
abstract: OBJECTIVE
  This study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA).
  
  
  METHODS
  We retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5-7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure.
  
  
  RESULTS
  In all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy.
  
  
  CONCLUSIONS
  The ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %).
authors.affiliation: Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, rimonu@sheba.health.gov.il.
authors.forename: Uri
authors.initials: U
authors.lastname: Rimon
authors.forename: Boris
authors.initials: B
authors.lastname: Khaitovich
authors.forename: Dmitry
authors.initials: D
authors.lastname: Yakubovich
authors.forename: Paul
authors.initials: P
authors.lastname: Bensaid
authors.forename: Gil
authors.initials: G
authors.lastname: Golan
authors.forename: Daniel
authors.initials: D
authors.lastname: Silverberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005471:Fluoroscopy; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D015641:Radiography, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D065506:Vascular Closure Devices