New Technique: Mini-invasive Proximal Control of the Bleeding After High Inguinal Puncture

Abstract

Introduction - There is growing amount of procedures with percutaneous inguinal access with large sheath patients who are very old and fragile. The bleeding or growing pseudoaneurysm at the access site is a typical complication, which need open surgical repair. Especially repair of punctures over inguinal ligament are related remarkable blood loss even with very talented surgeon. There is a need for development of the repair treatment. This new technique is very easy, simple and there is no need for x-ray or special equipments or skills. Methods - The treatment start for exposure of the superficial or common femoral artery just distal from the bleeding level. Then arterial puncture, J-wire 0.036” up to 20cm from inguinal level (J-wire did not go easily puncture hole) and then introducing 10cm long 7fr sheath. Then through the sheath no.4 standard Fogart balloon catheter just outside to the sheath about 10cm above inguinal ligament and fulfill the Fogart balloon. If working, there is not anymore pulse at the Common femoral artery. If not working, the balloon can be taken backward few centimeters surely inside iliac external vessel and fullfil again. Now there is proximal control of the injured area and the distal control is just taken by normal clamping. If the sheath or balloon location is not sure, the c-arm can be easily used and contrast media can be also in the balloon. Results - In our Hospital we have treated ten case during years 2014-2017. Four of the cases have been done by trainees without senior and six cases by specialist. Mean bleeding have been 60ml (30ml - 250ml) and there have been 5 cases after external iliac artery puncture of large sheet (18fr to 22fr) and some very obese patient. There was no need for c-arm use. Trainees did not want to use old basic technique anymore. Conclusion - In overall, this new technic is simple, and can be done with basic skills of vascular surgery. Especially technic is usefull for patients who can not tolerate bleeding and obese patients or patients with iliac artery injury.