Flip-over of blood vessel intima caused by vascular closure device:A case report

BACKGROUND Complications of vascular closure devices mainly include bleeding,vascular injury,and trapped device that cannot be removed percutaneously.However,arterial stenosis or occlusion induced by vascular injury is rare.This article introduces a rare case with severe acute limb ischemia after using the vascular closure device(StarClose).CASE SUMMARY A 54-year-old man was admitted because of necrosis of the second toe of the left foot for 2 mo.Ultrasound showed left femoral artery stenosis,and occlusion of the left popliteal,posterior tibial,peroneal,anterior tibial and dorsalis pedis arteries,suggesting arteriosclerosis obliterans of low extremities,gangrene and type 2 diabetes.He underwent an interventional procedure of drug-eluting balloon in the left lower limb via antegrade puncture of the left common femoral artery.He developed acute limb ischemia after 1 h,and severe pain,numbness,pale skin,low skin temperature and weakened sensation in the left foot.Injury of the common femoral artery intima was considered.Exploratory surgery showed occlusion at the puncture point accompanied with bulged vascular lumen and flipped vascular intima caused by StarClose.The flipped intima was removed.The limb blood supply was restored and the limb was saved post-surgery.He recovered well at final follow-up.CONCLUSION Incorrect use of the vascular closure device was the main cause of severe acute limb ischemia in this case.

Flexible Subclavian Artery Closure for an Inadvertent Injury to the Internal Mammary Artery During Internal Jugular Vein Catheterization

Central vein catheter （CVC） placement, which is widely utilized in clinical departments, is also highly important in preoperative preparations for radiofrequency catheter ablation （RFCA）. The internal jugular vein or subclavian vein is the routine target. Arterial injury is not uncommon during the procedure but is potentially devastating in spite of the safety and advantages of the Seldinger technique. Compressing of the airway by a hematoma, as well as hemothorax, pseudoaneurysm, arteriovenous fistula, stroke, and even death, has been well-described.

Outcomes of Clinical Application of Boomerang Closure Wire System

To evaluate the efficacy and safety of clinical application of a novel type of vascular closure device named Boomerang closure wire system （BCWS）. Methods BCWSs were hemostasis after transfemoral coronary angiography （CAG） or percutaneous used in 288 patients （BCWSs group） for coronary intervention （PCI）. Device success rate, hemostasis success rate, manual compression time, recumbent time, minor peripheral complication rate, severe peripheral complication rate and hospital staying time after procedure were analyzed. Results were compared to those from 300 patients （control group） who received manual compression in our hospital during the same period Results In BCWS group, device success rate was 97.2 %, hemostasis success rate was 95.1%. Manual compression time in CAG subgroup and PCI subgroup was 7.8 min and 11.2 min, respectively. Recumbent time was 136. 3 min in CAG subgroup, 284.6 min in PCI subgroup. Minor peripheral complication rate was 4.5 %, severe peripheral complication rate was 2. 4 %. Hospital-staying time after procedure in CAG group and PCI group was 1.8 d and 6. 6 d, respectively. Compared to control group, manual compression time, recumbent time and hospital-staying time of BCWSs group had statistical significance; hemostasis success rate, minor peripheral complication rate and severe peripheral complication rate of BCWSs group had no statistical difference. Conclusions BCWS provides satisfied haemostatic effect. Compared to routine manual compression, BCWS shortens manual compression time, recumbent time and hospital staying time. （ S Chin J Cardiol 2009; 10（1） ： 19 -22）