Endovascular Stent Placement for Vascular Closure Device Complications

Purpose: To assess the safety and efficacy of endovascular stent placement in the management of vascular closure device complications

Materials and Methods: We conducted a retrospective review of patients from a single practice who developed complications from vascular closure device deployment necessitating further intervention who were treated with endovascular stent placement.

Results: From June 2012 to November 2018, 16 patients (ages 63–99 years) diagnosed with vascular closure device complications were treated with endovascular stent placement. The Angio-Seal Vascular Closure Device was deployed in 15 patients, and the Perclose Proglide Suture-Mediated Closure System was deployed in 1 patient. Complications included access site severe stenosis (5), occlusion (9), and active hemorrhage (3). One patient had both an occlusion and active hemorrhage. Access sites included the common femoral artery (10) and the superficial femoral artery (6). All stenoses and occlusions were successfully treated with less than 30% residual stenosis in each case. All cases of active hemorrhage were successfully treated. Six patients had experienced thrombosis of an ipsilateral artery distal to the closure site, and these distal occlusions were successfully revascularized. There were no immediate complications associated with stent placement. Follow-up duplex imaging (range, 4-145 weeks) was available for 11 patients. Nine patients had widely patent stents. Two patients developed in-stent restenosis (defined as peak systolic velocity ratio >2.4). None of these patients progressed to the level of stent occlusion. One patient required target lesion revascularization using a combination of atherectomy, thrombolysis, thrombectomy, and angioplasty. Five patients were lost to follow-up. Four of these patients died of unrelated causes, and 1 is in hospice for lung cancer. None of these 5 patients required additional procedures for the target lesions before death or hospice.

Conclusions: Although rare, potential limb or life-threatening complications may develop after the use of vascular closure devices. Endovascular stent placement is a safe and effective treatment for vascular closure device complications.