Background: Femoral arterial closure devices are now commonly used after both diagnostic and therapeutic coronary procedures. They have been shown to reduce the time to ambulation and to decrease hospital length of stay. However, they have not been shown to reduce access site complications. Angioseal짰 (St. Jude Medical) is commercially available femoral artery closure devices approved by FDA. This sandwiches an intra-arterial absorbable anchor on the luminal side of the vessel and a thrombin plug on the surface of the vessel using a self cinching stitch. We report a case of a patient who presented with claudication that was found to be due to an Angioseal anchor having not resorbed appropriately.
Case: A 74-year-old male patient presented with right leg caudation and tingling sensation 40 days following a percutaneous coronary intervention and puncture site closed with a 6 Fr Angioseal. Physical examination was remarkable for reduced popliteal and pedal pulses. All left lower limb pulses were normal. Lower extremities Doppler studies had shown evidence of reduced arterial blood flow with a lesion at the iliac/common femoral artery level. An abdominal aortogram revealed normal common, external, and internal iliacs bilaterally. There was completely occluded lesion in the right common femoral artery at the level of the femoral head, at the site of the previous puncture. Using access via the right common femoral artery, we attempted balloon dilatation of the lesion was performed using 7��40mm balloon. Angiographycally, following balloon deflation, showed severe residual stenosis in the common femoral artery and no blood flow in the distal superficial femoral artery. The patient was transferred to the operating room and the material was removed surgically. The occluded proximal femoral artery was resected and was graft interposed with 8 mm Goretex vascular graft. Gross and microscopic findings demonstrated that the anchor of Angioseal not absorbed had induced foreign body reaction with fibrosis and eventually obstructed the vascular lumen. The patient had an uncomplicated postoperative recovery, being discharged on postoperative day 7, and one month later was well with no recurrent symptoms.