PURPOSE: Pseudoaneurysms after percutaneous vascular access are common and potentially fatal if left untreated. The aim of this study was to determine the incidence and risk factors associated with access site pseudoaneurysms after endovascular intervention for peripheral arterial disease (PAD) under a routine postintervention ultrasound (US) surveillance protocol. METHODS: A total of 254 PAD interventions were performed in a single center between January 2015 and November 2016, and puncture site duplex US surveillance was routinely performed within 48 hours of the procedure. Clinical, procedural and follow-up US data were analyzed. RESULTS: The overall incidence of pseudoaneurysm was 2.75% (6 cases in the femoral artery and 1 in the brachial artery). There was no difference between retrograde and antegrade approach, but there was a higher rate of pseudoaneurysm formation after manual compression compared to arterial closure device (ACD) use (4.3% vs. 0.87%). Manual compression was more commonly used for antegrade punctures (79.0%) and ACD for retrograde punctures (67.7%). Calcification was more frequently found in antegrade approach cases (46.8% vs. 16.9% for retrograde cases) and manual compression was preferred in its presence. All pseudoaneurysms were treated successfully at the time of diagnosis by US-guided compression repair and there were no cases of rupture. CONCLUSION: Pseudoaneurysm rates after therapeutic endovascular intervention for PAD were comparable to other cardiologic or interventional radiologic procedures despite the higher possibility of having a diseased access vessel. Routine US surveillance of access sites allowed for early diagnosis and noninvasive treatment of pseudoaneurysms, preventing potentially fatal complications.
Aneurysm, False ; Diagnosis ; Early Diagnosis ; Endovascular Procedures ; Femoral Artery ; Follow-Up Studies ; Incidence ; Peripheral Arterial Disease ; Punctures ; Risk Factors ; Rupture ; Ultrasonography ; Vascular Closure Devices

PURPOSE: The purpose of this study was to examine the effects of bed angles and bed rest time combined with hemostatic methods on discomfort and hemorrhagic complications in patients after transfemoral cerebral angiography. METHODS: Data were collected from 93 inpatients following transfemoral cerebral angiography, from April 20 to September 23, 2016. Patients were grouped according to bed angle (0° vs. 30°) and bed rest time combined with hemostatic methods (4-hour bed rest after manual compression vs. 2-hour bed rest after applying vascular closure device). RESULTS: There was a significant group differences on discomfort (F=46.44, p<.001). The post-hoc analysis showed the lowest score of discomfort in those with bed angle 30o and 2-hour bed rest. There was no difference in hemorrhagic complications among 4 groups. CONCLUSION: The postangiograpy discomfort can be effectively reduced with the least hemorrhagic complications by bed angle 30° elevation and 2-hour bed rest after applying vascular closure device for those underwent transfemoral cerebral angiography.
Bed Rest ; Cerebral Angiography ; Hemorrhage ; Humans ; Inpatients ; Methods ; Vascular Closure Devices

Accidental subclavian artery cannulation is an uncommon but potentially serious complication of central venous catheterization. Removal of a catheter inadvertently placed in the subclavian artery can lead to substantial bleeding, as achieving hemostasis in this area through manual compression presents considerable difficulty. Additionally, surgical treatment might be unsuitable for high-risk patients due to comorbidities. Here, we report a case of an inadvertently-inserted 11.5-French hemodialysis catheter in the subclavian artery during internal jugular venous catheterization. We performed percutaneous closure of the subclavian artery using three 6-French Perclose Proglide® devices with a balloon tamponade in the proximal part of the subclavian artery. Closure was completed without embolic neurological complications.
Balloon Occlusion* ; Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Comorbidity ; Hemorrhage ; Hemostasis ; Humans ; Renal Dialysis* ; Subclavian Artery* ; Vascular Closure Devices

OBJECTIVETo evaluate the long-term outcome of the femoral artery following total percutaneous endovascular aortic repair (EVAR) with preclose technique using a vascular closure device (VCD).

METHODSFrom July, 2009 to July, 2012, total percutaneous EVAR was performed in 113 patients (106 males, 7 females; mean age 59.4∓13.5 years) with pre-close technique, including 60 with Stanford type B aortic dissection, 3 with thoracic aortic aneurysm, and 48 with infra-renal abdominal aortic aneurysm, and 2 with thoracic and abdominal aortic aneurysms. The Technical success and complication rates were evaluated, and the outcomes of the femoral artery were followed up with computed tomography or color Doppler ultrasound.

RESULTSThe overall technical success rate was 97.6% (161/165) with conversion to open surgery in 4 cases. The size of the sheaths used were 24Fr (n=37), 22Fr (n=29), 20Fr (n=24), 18Fr (n=25), 16Fr (n=12) and 14 Fr (n=38), and 347 VCDs were used for hemostasis of 165 femoral sites; 147 femoral sites were closed using 2 VCDs. Four access-related adverse events, including femoral arterial-venous fistula, acute femoral thrombosis, bleeding, and lower extremity ischemia, occurred in 4 (2.4%) of the 165 cases. In cases using ≤18Fr sheaths, the success rate of closure using 2 VCDs was 98.7%, as compared to 81.1% in cases using larger (≥20Fr) sheaths (P=0.0003). The success rate of the 82 anterior sites was lower than that of the 82 posterior sites (82.9% vs 95.2%, P=0.013). No lower extremity ischemia was observed, nor was femoral artery stenosis detected during the follow-up for 26∓9 months (12-50 months) in these cases.

CONCLUSIONTotal percutaneous EVAR with preclose technique using VCD provides a safe and effective alternative to open femoral surgery. The sheath size can be a predictor of percutaneous access failure to require conversion to open femoral surgery or using more than 2 devices for suture. Total percutaneous endovascular aortic repair using VCD with preclose technique is safe and effective, which can be adopted as an alternative technique of surgically femoral arterial cut-down operation when the surgeon reduce the learning curve.

Aged ; Aneurysm, Dissecting ; Angiography ; Aortic Aneurysm, Abdominal ; Aortic Aneurysm, Thoracic ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Femoral Artery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color ; Vascular Closure Devices