Infectious arteritis of the femoral artery as a cause of recurrent hemorrhage after endovascular treatment of thrombosed popliteal artery aneurysm.
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Abstract
Due to a great number of endovascular interventions, conducted over the last decades, a huge percentage of obese patients and administration of double antiplatelet therapy, manual compression (MC) is more and more frequently replaced by a vascular closure device of which the most common is Angio-Seal. The study presents a case of a 63-year old female patient with recurrent hemorrhages of the common femoral artery (CFA), originally closed after an endovascular intervention of a popliteal artery aneurysm with the use of Angio-Seal VIP. After around 3 weeks following the original surgery, the patient at first developed a pseudoaneurysm and then septic inflammation of the femoral artery, manifested with recurrent hemorrhages from the groin. The patient was operated on many times and an implantation of an ilio-femoral bypass from the femoral vein turned out to be an effective solution. Staphylococcus epidermidis MRSA was cultured in the femoral artery wall and a histopathological examination confirmed infectious arteritis. The presented case of a rare septic complication after the application of a closure device shows that it is essential to carefully monitor surgical approach areas in patients who are quickly discharged from hospital after surgical interventions, to select treatment methods tailored for individual patients as well as implement particular surgical management.
Keywords: Angio-Sealinfectious complicationspseudoaneurysmvascular closure devicepopliteal artery aneurysm
References
- Iannaccone M, Saint-Hilary G, Menardi D, et al. Network meta-analysis of studies comparing closure devices for femoral access after percutaneous coronary intervention. J Cardiovasc Med (Hagerstown). 2018; 19(10): 586–596.
- Arora N, Matheny ME, Sepke C, et al. A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. Am Heart J. 2007; 153(4): 606–611.
- Nash JE, Evans DG. The Angio-Seal hemostatic puncture closure device. Concept and experimental results. Herz. 1999; 24(8): 597–606.
- Noori VJ, Eldrup-Jørgensen J. A systematic review of vascular closure devices for femoral artery puncture sites. J Vasc Surg. 2018; 68(3): 887–899.
- Saleem T, Baril DT. Vascular Access Closure Devices. [Updated 2020 Jan 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.
- Wu PJ, Dai YT, Kao HL, et al. Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for haemostasis. BMC Cardiovasc Disord. 2015; 15: 34.
- Lucatelli P, Fanelli F, Cannavale A, et al. Angioseal VIP® vs. StarClose SE® closure devices: a comparative analysis in non-cardiological procedures. J Cardiovasc Surg (Torino). 2017; 58(1): 80–86.
- Carey D, Martin JR, Moore CA, et al. Complications of femoral artery closure devices. Catheter Cardiovasc Interv. 2001; 52(1): 3–7; discussion 8, doi: 10.1002/1522-726x(200101)52:1<3::aid-ccd1002>3.0.co;2-g.
- Frazee BW, Flaherty JP. Septic endarteritis of the femoral artery following angioplasty. Rev Infect Dis. 1991; 13(4): 620–623.
- Abando A, Hood D, Weaver F, et al. The use of the Angioseal device for femoral artery closure. J Vasc Surg. 2004; 40(2): 287–290.
- Cooper CL, Miller A. Infectious complications related to the use of the angio-seal hemostatic puncture closure device. Catheter Cardiovasc Interv. 1999; 48(3): 301–303, doi: 10.1002/(sici)1522-726x(199911)48:3<301::aid-ccd15>3.0.co;2-f.