Clip-based arterial haemostasis after antegrade common femoral artery puncture

Abstract

Background Given the frequent involvement of infra-popliteal arteries, an ipsilateral antegrade common femoral artery puncture (ACFAP) is usually preferred to a contralateral retrograde femoral access for percutaneous transluminal angioplasty (PTA) in patients with critical limb ischemia (CLI). Because of the frequent difficulty to get a sufficient manual pressure on the puncture site, ACFAP is burdened by a high number of bleeding local complications, including retroperitoneal haematoma. We report a series of patients who consecutively received a clip-based arterial closure device after ACFAP and ipsilateral PTA for CLI. Methods Thirty patients (73 ± 6 years; 18 men; 100% diabetes) admitted to our hospital because of CLI consecutively underwent peripheral PTA after an ACFAP and received a clip-based arterial closure device. Time to haemostasis was defined as the interval elapsed between clip deployment and first observed haemostasis. All patients were mobilized after 6 h. Follow-up was 30 days. Results All patients were on double anti-platelet therapy. At the end of the procedure, Activation Clotting Time was 226 ± 37 s. Procedural success in delivering the clip was 100%. Time to haemostasis was 21 ± 19 s. No major local vascular complications and in particular no retroperitoneal bleeding were documented. All patients could be discharged within the following 3 days. No major complications were noted during a 30 days follow-up. Conclusions The use of a clip-based arterial closure device after ACFAP for peripheral PTA in CLI seems to be safe and effective.