Vascular Closure and Devices Flashcards
What is the limitation of using one Perclose, Angio-Seal, or Mynx device for sheaths above 10 Fr?
They cannot be closed with one device
Vascular closure may be performed by deploying two Perclose ProGlide sutures in a “preclose” fashion.
What is the Manta vascular closure device designed for?
Large-bore procedures requiring devices up to 19 Fr
The device is currently not approved in the United States.
What was the success rate reported in the first prospective feasibility study of the Manta device?
94% success rate at hemostasis
The study included 50 patients and reported one major complication requiring vascular surgery.
What is the instruction for re-entry at the same location of previous Angio-Seal device use within 90 days?
Re-entry 1 cm proximal to the previous access site can be performed safely
A femoral angiogram of the site is indicated before considering Angio-Seal use.
True or False: The Mynx device was associated with a decreased risk of vascular complications.
False
Use of the Mynx device was associated with an increased risk of any vascular complications.
What is a pseudoaneurysm and how is it typically managed if size is less than 1 cm?
An infrequent complication of transradial catheterization, usually managed conservatively
Thrombin injection is not recommended for radial artery pseudoaneurysms.
What is the most likely explanation for acute limb ischemia in a patient post-procedure?
Acute dissection with thrombotic occlusion
This requires urgent imaging and intervention.
What is the best next step in managing a radial artery perforation?
Cross the perforation with a 0.014-in. wire and place a long sheath
This results in tamponade of the vessel.
List three advantages of vascular closure devices.
- Reduced time spent in manual compression
- Improved patient flow
- Earlier ambulation for some patients
What does the American Heart Association (AHA) recommend regarding the routine use of closure devices?
Class III recommendation against routinely using closure devices to reduce vascular complications
This is based on their scientific statement.
What device is associated with a risk of major complications from vascular closure devices?
1% to 2% risk
This includes complications such as acute femoral artery thrombosis.
What common comorbidities were identified in closure device-related infections?
- Diabetes mellitus
- Obesity
What is the median incubation period for access-site infection after device insertion?
8 days
The range is from 2 to 29 days.
What imaging is useful for diagnosing a pseudoaneurysm?
Ultrasound imaging
This can help make the diagnosis and guide management.
What complication may occur with a ‘high stick’ access site?
Increased incidence of retroperitoneal hemorrhage
Closure device use is also associated with this complication.
What is the risk associated with using closure devices in patients with severe atherosclerosis at the access site?
None of the currently available devices are approved for use
This includes extravascular closure devices.
What symptoms are consistent with a pseudoaneurysm?
- Pulsatile mass
- Audible bruit
What are the components of the Angio-Seal device?
- Polylactic–glycolic acid anchor
- Bioresorbable collagen suture
- Bovine collagen extravascular sponge
Fill in the blank: The incidence of acute vessel closure at the time of device deployment has decreased to <_______ in most series.
0.1%
