Acute Limb Ischemia Due to Retention of Collagen Plug

Abstract

Vascular closure devices following cardiac catheterization through the femoral artery have been gaining significant traction. Compared to the previous gold standard of manual compression, VCDs allow for shortened time to ambulation, decreased duration of hospitalization post procedure, and quicker hemostasis. Despite the advantages and variety of devices available, there are still complications to take into account. Our patient is a 74-year-old female who presented with intermittent right lower extremity pain. Her symptoms began two weeks prior to presentation, shortly after a recent left heart catheterization that was performed for chest pressure despite normal stress testing. A right lower extremity Doppler demonstrated decreased blood flow and a thrombus was presumed in the superficial femoral artery. After failed attempts of trying to retrieve the thrombus through a spider distal protection device and then a 7-French sheath, the patient was taken to the operating room. Specimens removed were identified as the Angio-Seal plug from the left heart catheterization. In conclusion, risk factors associated with VCD complications should be fully assessed due to the possibility of serious complications. In addition, misinterpretation can lead to delayed or incorrect treatment. Angio-Seal has proven to be highly efficacious, however, further studies will be needed to avoid device related complications.