Feasibility of Vascular Access Closure in Arteries Other Than the Common Femoral Artery Using the ExoSeal Vascular Closure Device

Abstract

To describe the feasibility of vascular access closure in arteries other than the common femoral artery (CFA) using the ExoSeal vascular closure device (VCD). Between December 2011 and August 2013, 8 patients (4 males, 4 females, mean age 64 years [range 42-81]) underwent 13 extrafemoral access site closure using the ExoSeal VCD (brachial artery n = 7, venous femoropopliteal bypass n = 3, femoropopliteal segment n = 2, proximal superficial femoral artery n = 1). Patient history, procedural characteristics, and complications were recorded. Technical success was achieved in 12 of 13 VCD procedures. In 1 case of brachial puncture, safe plug-deployment was not possible, so manual compression was applied. In this case, angiographic and clinical control showed residual bleeding 5 min after the procedure. After additional manual compression for 5 min, the haemorrhage stopped, but a hematoma <3 cm was detectable (procedural success rate 12 of 13 closures). Overall no major complications were observed. Heparin, 5,000 IU, was administered in all cases. Six ExoSeal closures were performed under additional acetylsalicylic acid (ASS) and clopidogrel, three under additional ASS, and the remaining four under heparin only. International normalized ratio and thrombocytes were within normal values in all patients. Successful vascular access closure using the ExoSeal VCD in puncture sites other than the CFA is feasible with a low complication rate. These applications, however, remain an "off-label" use in selected patients.