Abstract
Vascular closure devices are frequently used for hemostasis during endovascular procedures by employing sutures, plug devices (using collagen or hydrogel) or through the use of a metal clip made of nickel and titanium as with the StarClose device. We present a case where a StarClose SE vascular closure device (VCD) was deployed for hemostasis post diagnostic cardiac catheterization and upon repeat access, four days later for coronary intervention, retrograde sheath angiography revealed a pseudo-aneurysm emanating from the center of the StarClose clip. Review of literature indicates StarClose to be safe and effective in achieving hemostasis in majority of endovascular procedures and the incidence of pseudo-aneurysm to be infrequent.
Highlights
Femoral arterial hemostasis post cardiac catheterization can be achieved through manual compression (MC), mechanical compression or vascular closure devices (VCDs)
I n d eciding the method of arterial closure, MC versus VCD, one must take into account numerous factors including the site of arterial puncture to minimize VCD related complications
Prospectively compared Starclose with MC and collagen plug based angio-seal device, showing significantly higher number of starclose patients requiring additional manual compression to achieve hemostasis, the incidence of major complications was lowest with StarClose patients (1.9%) vs angioseal (2.9%) and greatest with MC (3.7%) [11]
Summary
Femoral arterial hemostasis post cardiac catheterization can be achieved through manual compression (MC), mechanical compression or vascular closure devices (VCDs). A 77-year-old man with history of ischemic cardiomyopathy with left ventricular ejection fraction 20-25% and atrial fibrillation was transferred to our hospital post cardiac arrest He was noted to have positive troponins and was diagnosed with NSTEMI. Hemostasis post-procedure was achieved with a StarClose SE device with no post deployment oozing or delayed hemostasis. He was felt to be at extreme surgical risk and was referred for highrisk percutaneous coronary intervention (PCI). Prior to PCI, retrograde sheath angiography was performed to evaluate the access site for hemostasis and suitability for closure. There was no post-compression bleeding, oozing or other postprocedure complications
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