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Home > Vascular Annual Meeting > PP40. An Algorithm for Optimal Utilization of Percutaneous Closure Devices

PP40. An Algorithm for Optimal Utilization of Percutaneous Closure Devices

Samuel S. Ahn1, Julia F. Chen1,2, Christopher Kim1, Kevin Peng1
1University Vascular Associates, Los Angeles, CA; 2DFW Vascular Group, Dallas, TX

OBJECTIVES: To introduce an algorithm which has been successful in minimizing complications related to the use of percutaneous closure devices. The following algorithm was implemented as follows: Perclose was the default closure device used, except in cases where the artery was very calcified or had dense scar tissue, in which case the Angioseal was the first choice. If a Perclose failed, the Angioseal was attempted. If an Angioseal failed, pressure was held for 15-30 minutes without peeking. If holding pressure failed, a Femostop (Radi Medical) was applied.

METHODS: The author made 201 punctures in 191 (103 male, 88 female) patients undergoing endovascular procedures from April 2006 to October 2008. Risk factors included arrhythmia (n=12, 6.28%), coronary artery disease (n=55, 28.80%), congestive heart failure (n=9, 4.71%), diabetes (n=73, 38.22%), dialysis (n=9, 4.71%), hyperlipidemia (n=43, 22.51%), hypertension (n=119, 62.30%), COPD (n=13, 6.81%), history of MI (n=26, 13.61%), TIA/CVA (n=7, 3.66%). ASA classifications were I (n=9, 4.71%), II (n=35, 18.32%), III (n=115, 60.21%) and IV (n=23, 12.04%). Failure of the closure device was defined as persistent bleeding requiring manual pressure, formation of a hematoma, blood transfusion, or hospitalization. Failure of the algorithm was defined as formation of a hematoma, blood transfusion or hospitalization.

RESULTS: Perclose was selected as the first choice in 78.11% (n=157) of punctures and the Angioseal was selected in 17.80% (n=44). The failure rate for each device was 15.91% (n=7) for Angioseal and 8.92% (n=14) for Perclose. The overall failure rate was 10.45%. All Angioseal failures were successfully treated with manual compression. Perclose failures were ultimately treated with an attempt at another closure device (n=6), manual compression (n=6), or a Femostop (n=2). Average recovery time was 1 hour 37 minutes (range: 23 minutes to 4 hours 48 minutes; SD: 39 minutes). 99.48% (n=190) of patients were discharged same day; 0.52% (n=1) was admitted for thromboemboli. The final failure rate of the algorithm was zero.

CONCLUSIONS: The described algorithm minimizes closure device-related complications. Implementation of this algorithm increases the safety of performing endovascular interventions in an office angiosuite.

AUTHOR DISCLOSURES: S.S. Ahn, Vascular Management Associates; J.F. Chen, Vascular Management Associates; C. Kim, None; K. Peng, Vascular Management Associates.