1/16. Sequential retroperitoneal venous hemorrhage and embolism of an angio-seal puncture closure device complicating iliac artery angioplasty.PURPOSE: To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma. methods AND RESULTS: A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. Angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure. CONCLUSIONS: RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/16. Interventional therapy of vascular complications caused by the hemostatic puncture closure device angio-seal.The hemostatic puncture closure device Angio-Seal is a quick, safe, and easy-to-use system, allowing rapid sealing of the vascular access site following coronary angiography and interventional procedures. It is advantageous for patients in whom early mobilization is desired and may therefore decrease hospital costs. Despite the documented low complication rate, there are some specific problems. Reporting on five cases, we describe problems in diagnosis and possible interventional therapy of Angio-Seal-associated complications such as stenosis, occlusion, or peripheral embolism. Our experience led to the concept of precise diagnosis in any patient with leg symptoms and early interventional treatment with the aim of complete removal of the intra-arterial parts of the Angio-Seal device. Any delay in diagnosis and treatment increases the risk of additional thrombotic occlusion. Spontaneous dissolution of the Angio-Seal sponge limits interventional possibilities of complete removal. Cathet. Cardiovasc. Intervent. 49:142-147, 2000.- - - - - - - - - - ranking = 0.55555555555556keywords = puncture (Clic here for more details about this article) |
3/16. Primary stenting for chronic total occlusion of the infrarenal aorta.PURPOSE: To present a rare case of chronic total occlusion of the infrarenal aorta treated with a self-expanding endoluminal stent implanted without preliminary dilation. methods AND RESULTS: A 68-year-old woman presented with severe bilateral buttock and thigh claudication. Angiography revealed total occlusion of the infrarenal abdominal aorta and relatively normal iliac vessels. Via a right groin puncture and a 9-F sheath, a 14-mm x 5-cm self-expanding Wallstent was deployed in the abdominal aorta and expanded with an angioplasty balloon. Completion angiography showed successful recanalization of the aorta with satisfactory distal flow. Palpable distal pulses were restored, and the patient's symptoms were alleviated. She remained asymptomatic until her death from a major stroke 11 months after aortic stent implantation. CONCLUSIONS: Primary stenting may be considered a viable alternative to conventional surgery in selected patients with total infrarenal aortic occlusion.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
4/16. Bilateral transpopliteal approach for treatment of complex SFA and iliac occlusions.We present a successful case of percutaneous intentional extraluminal recanalization (PIER) of bilateral long superficial femoral artery (SFA) occlusions and a long iliac artery occlusion through ultrasound-guided retrograde popliteal artery punctures. To our knowledge, PIER of SFA occlusions via popliteal approach has been reported in only three cases, and subintimal recanalization of combined SFA and iliac occlusions has not been reported.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
5/16. hematoma after percutaneous transpopliteal stenting and remote suturing of the popliteal artery.PURPOSE: To present a case of extensive thigh hematoma that developed after use of a percutaneous suturing device for retrograde popliteal artery puncture. CASE REPORT: A 55-year-old woman underwent endovascular treatment for a short occlusion of the right superficial femoral artery via a retrograde popliteal approach, after which the puncture site was closed with a Closer suture-mediated device. Several hours later, massive hematoma of the right thigh developed, which was noticed only after the patient's leg became markedly swollen and hypotension developed. CONCLUSIONS: The use of a suture-mediated closure device for a retrograde popliteal artery puncture may not be recommended.- - - - - - - - - - ranking = 0.33333333333333keywords = puncture (Clic here for more details about this article) |
6/16. Endovascular stent graft treatment for iatrogenic arteriovenous fistulas after femoral catheterisation.This article presents a case report of a 79-year-old patient who was suffering from a large femoral arteriovenous fistula and a stenosis of the external iliac artery and who was treated successfully with stent grafts. The fistula, which consisted of three parts, was caused by a percutaneous transluminal coronary angioplasty. Two Jo-stents and one Medtronic AVE stent were used to cover the fistula and to dilate the stenosis. This article also describes the possible causes of iatrogenic arteriovenous fistulas such as the technique of arterial puncture and its localisation. The treatment of iatrogenic arteriovenous fistulas with stent grafts is a safe alternative for surgery in patients who often suffer from multiple cardiovascular problems. It could become the treatment of choice in the future.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
7/16. Subintimal recanalization of the femoropopliteal segment to promote healing of an ulcerated below-knee amputation stump.PURPOSE: To describe the use of the subintimal technique to revascularize an ulcerated below-knee amputation stump. CASE REPORT: A 64-year-old man with persistent ulceration of a below-knee amputation stump underwent attempted percutaneous revascularization. Via antegrade puncture, the femoropopliteal occlusion was recanalized subintimally and eventually opened into a large medial geniculate collateral branch, improving the stump flow. The procedure was uneventful, and at 6 months, the patient was pain-free and able to mobilize with his prosthetic limb. CONCLUSION: Subintimal revascularization of a critically-ischemic below-knee amputation stump may be a useful option and should be considered in clinical situations like this.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
8/16. Complications associated with the Angio-Seal arterial puncture closing device: intra-arterial deployment and occlusion by dissected plaque.The Angio-Seal arterial closure device is widely used to prevent bleeding and facilitate early ambulation after arterial puncture. We had referred to us three female patients in whom this device had been used; its sponge had been unintentionally deployed in the arterial lumen. In a fourth female patient, a dissected plaque underneath the device occluded the femoral artery. Severe lower extremity ischemia occurred in each case. One intraluminal sponge was detected only after 20 days, when the patient had developed severe symptoms due to microembolization; in another patient, ischemia occurred 9 days after intraluminal deployment. In two, or possibly three, of the cases, the superficial femoral artery had been punctured. The device should not be used when the superficial femoral artery has been punctured, in which case complications are more likely to occur. Lower limb ischemia within several months after deployment of these devices should be investigated with duplex ultrasound scanning to examine the possibility that the ischemia may be caused by the device or by device-related thrombus. It is important to register the use of such devices in the procedural reports to make it possible to link their use to eventual later ischemic events.- - - - - - - - - - ranking = 0.77777777777778keywords = puncture (Clic here for more details about this article) |
9/16. Left axillary approach for balloon recanalization of an occlusion of the right common femoral artery.Percutaneous angioplasty of an occlusion of the right common femoral artery was attempted through the left axillary route. The problem of negotiating the occlusion was solved by the use of Magnum guidewire and a Probing catheter. Symptomatic improvement was achieved and there were no complications at the puncture site.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
10/16. The use of double guidewires through a single vascular sheath for obtaining profunda femoris arterial access: technical note.We describe a double guidewire/single vascular sheath technique that facilitates dilatation of stenotic lesions within both the superficial femoral and profunda femoris arteries following a single antegrade common femoral arterial puncture. Such a technique prevents inadvertent loss of vascular access during maneuvers to catheterize the profunda femoris artery or the superficial femoral artery. angioplasty within the superficial femoral artery with simultaneous safety-wire placement within the profunda femoris artery has been described previously, but we present, in this technical note, successful profunda femoral angioplasty with the safety wire within the superficial femoral artery.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
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