RESUMO
Vascular closure devices (VCDs) are being increasingly used for achieving hemostasis after diagnostic and therapeutic endovascular procedures. Although uncommon, complications may be encountered which are associated with the use of these VCDs. We report four cases where the use of Angio-Seal (Terumo, Somerset, New Jersey, USA) was followed by complications. Three cases presented with acute limb ischemia, among them, two patients had arterial occlusion at the vascular access site and one patient had embolization of the footplate anchor of the closure device. One case presented with pseudoaneurysm at the common femoral artery access site along with occlusion at origin of the superficial femoral artery. We have described the mechanism in which these complications occur and the successful management of these cases preventing potential amputation and limb loss. The risk factors which increase the risk of complications with the use of Angio-Seal VCD were reviewed and the strategy to avoid these complications with particular emphasis on the utility of ultrasound when using Angio-Seal VCD is discussed. A strategy to manage these complications has been discussed while deciding on endovascular management or surgical management, especially in patients with challenging presentation and those with multiple comorbidities making them at very high risk for surgery.
RESUMO
Pseudoaneurysm with arteriovenous fistula is a rare presentation of penetrating trauma, occurs when trauma involves major blood vessels, and is traditionally treated surgically. Recently, these are more commonly treated using endovascular techniques which include stent graft placement and parent artery occlusion. In this case report, we present a case of femoral artery pseudoaneurysm and arteriovenous fistula with severe size difference between the arterial segments proximal and distal to the fistula site, treated successfully by using the upside-down gore excluder limb technique.
