Antegrade use of a collagen based vascular closure device for day case peripheral stenting: when can we safely discharge the patients?

Iftikhar Zaman, Tariq Ali, Cormac O’Neil, Renganaden Pyneeandee, Miltiadis Krokidis

Abstract


Purpose: Vascular closure devices have revolutionised vascular intervention, offering early patient mobilisation after retrograde access. The purpose of this study is to assess the safety and cost saving performance of a collagen based closure device in the early mobilisation of patients that undergo antegrade peripheral stenting as day cases.

Material and Methods: We retrospectively reviewed our radiology day unit database for antegrade stenting cases in a four-year period. We included 26 patients where a collagen based closure device was used. Patients were analysed for size of sheath used, Rutherford classification, degree of calcification (score from 1-4) of the access artery, amount of inraprocedureal heparin, type of stent used, time of discharge, immediate and delayed complications. Cost analysis also followed aiming to identify potential cost benefits of the device.

Results: A 6 Fr sheath was used in all cases. 11/26 patients were Rutherford 5-6 classification. The degree of calcification was >3 in 20/26 patients. In all patients at least 3000 IU of heparin were used intraprocedurally. Two types of stents were used; the time of discharge was 4 hours. In two cases a small haematoma was detected but did not change the management of the patients. No delayed groin complications occurred.  Bed turnover was 50% less than with the traditional 6-hour stay, leading to significant reduction of the healthcare costs.

Conclusions: The use of a collagen based closure device offers satisfactory day case results for patients with advanced peripheral disease that undergo antegrade stenting, with reduction of the overall procedure cost.


Keywords


Peripheral vascular intervention; Antegrade access; Vascular closure devices; Day-case angioplasty

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References


Popma JJ, Satler LF, Pichard AD, et al. Vascular complications after balloon and new device angioplasty. Circulation 1993; 88: 1569–1578.

Nasser TK, Mohler ER, Wilensky RL, et al. Peripheral vascular complications following coronary interventional procedures. Clin Cardiol 1995; 18: 609–614.

Ratnam LA, Raja J, Munneke GJ, et al. Prospective non-randomized trial of manual compression and Angio-Seal and Starclose arterial closure devices in common femoral punctures. Cardiovasc Intervent Radiol 2007; 30(2): 182–188.

Das R, Ahmed K, Athanasiou T, et al. Arterial closure devices versus manual compression for femoral haemostasis in interventional radiological procedures: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 2011; 34(4): 723–738.

Nice C, Timmons G, Bartholemew P, et al. Retrograde vs antegrade puncture for infra-inguinal angioplasty. Cardiovasc Intervent Radiol 2003; 26(4): 370–374.

Duda SH, Wiskirchen J, Erb M, et al. Suture-mediated percutaneous closure of antegrade femoral arterial access sites in patients who have received full anticoagulation therapy. Radiology 1999; 210(1): 47–52.

Chaudhuri A, York A, Dey R. Percutaneous vascular closure using an anchored collagen plug provides effective haemostasis following both antegrade and retrograde femoral arterial punctures. Eur J Vasc Endovasc Surg 2014; 48(2): 220-225.

Fanelli F, Cannavale A, Gazzetti M, et al. Calcium burden assessment and impact on drug-eluting balloons in peripheral arterial disease. Cardiovasc Intervent Radiol 2014; 37: 898-907.

St Jude Medical. Angio-Seal evolution vascular closure device: Instructions to use. http://www.pei.ie/PEI/media/PEI-media/PDFs/PDFs_Cardiac/PDFs_Cardiac_Products/angio-seal_evolution_ifu_us.pdf

Mukhopadhyay K, Puckett MA, Roobottom CA. Efficacy and complications of Angioseal in antegrade puncture. Eur J Radiol 2005; 56(3): 409-412.

Biondi-Zoccai GG, Fusaro M, Tashani A, et al. Angio-Seal use after antegrade femoral arteriotomy in patients undergoing percutaneous revascularization for critical limb ischaemia: a case series. Int J Cardiol 2007; 118: 398–399.

Kapoor B, Panu A, Berscheid B. Angio-Seal in antegrade endovascular interventions: Technical success and complications in a 55-patient series. J Endovasc Ther 2007; 14 (3): 382–386.

Looby S, Keeling AN, McErlean A, et al. Efficacy and safety of the Angio-Seal vascular closure device post antegrade puncture. Cardiovasc Intervent Radiol 2008; 31: 558–562.

Lupattelli T, Tannouri F, Garaci FG, et al. Efficacy and safety of antegrade common femoral artery access closure using the Angio-Seal device: experience with 1889 interventions for critical limb ischemia in diabetic patients. J Endovasc Ther 2010; 17(3): 366–375.

Minko P, Katoh M, Gräber S, et al. Obesity: An independent risk factor for insufficient hemostasis using the angioseal vascular closure device after antegrade puncture. Cardiovasc Intervent Radiol 2012; 35(4): 775-778.


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