Annals of vascular surgery · 2018
Possible Mechanism for Common Femoral Artery Occlusion with the Perclose Suture Device.
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Archie Mark, Farley Steven
Аннотация
BACKGROUND: Common femoral artery (CFA) occlusion by the Perclose suture device has been rarely reported in the literature. Authors and industry have no proposed mechanism. A review of patients who required operative repair may identify a possible mechanism for CFA occlusion.
METHODS: At a single center, 2 patients were identified with CFA occlusion due to posterior CFA wall suturing. Vessel characteristics, angiographic, and intraoperative findings were reviewed.
RESULTS: In both patients, the CFA diameter was >5 mm with no evidence of atherosclerotic plaque. Puncture sites by angiogram were near vessel branch points-the inferior epigastric and profunda femoris. Intraoperative findings identified posterior CFA suturing at the origin of a branch vessel as the mechanism for vessel occlusion.
CONCLUSIONS: CFA occlusion by the Perclose device is the result of suture firing into the posterior CFA wall, which requires interposition of the vessel between the footplate and suture needles. The proposed mechanism is anchoring of the footplate in the origin of the branch vessel, which allows for capture of the posterior CFA wall. Technical reasons may include high or low puncture near CFA branches, less than 45° angulation of the device in relation to the CFA, and axial rotation of the device, which may allow for footplate anchoring in the branch vessel origin.
METHODS: At a single center, 2 patients were identified with CFA occlusion due to posterior CFA wall suturing. Vessel characteristics, angiographic, and intraoperative findings were reviewed.
RESULTS: In both patients, the CFA diameter was >5 mm with no evidence of atherosclerotic plaque. Puncture sites by angiogram were near vessel branch points-the inferior epigastric and profunda femoris. Intraoperative findings identified posterior CFA suturing at the origin of a branch vessel as the mechanism for vessel occlusion.
CONCLUSIONS: CFA occlusion by the Perclose device is the result of suture firing into the posterior CFA wall, which requires interposition of the vessel between the footplate and suture needles. The proposed mechanism is anchoring of the footplate in the origin of the branch vessel, which allows for capture of the posterior CFA wall. Technical reasons may include high or low puncture near CFA branches, less than 45° angulation of the device in relation to the CFA, and axial rotation of the device, which may allow for footplate anchoring in the branch vessel origin.