Successful surgical retrieval of Celt ACD\xae vascular closure device embolised in the tibioperoneal trunk

Qusai Aljarrah,Ahmad Althaher,Ma’Moon Al-Omari,Jozef Oweis,Kawthar Qader

doi:10.1186/s42155-018-0013-5

Qusai Aljarrah, Ahmad Althaher + Show 3 more

Open Access

https://doi.org/10.1186/s42155-018-0013-5

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Abstract

BackgroundThis report presents a case of surgical retrieval of a Celt ACD® vascular closure device (VCD) situated in the tibioperoneal trunk, following a failed attempt at deployment. Existing literature mostly recommends an endovascular approach when attempting to retrieve embolised VCDs.Case presentationA 55 year old male presented with right sudden right lower limb pain and numbness 1 week following a successful left retrograde superficial femoral artery (SFA) angioplasty. Computed tomography (CT) angiogram revealed that the Celt ACD® VCD had embolised in the right tibioperoneal trunk. An endovascular approach was initially attempted to retrieve the VCD; however, this was unsuccessful due to the small diameter of the target artery. Due to the failure of the endovascular approach, surgical exploration of the right tibioperoneal trunk was undertaken, which led to the successful retrieval of the embolised VCD.ConclusionThe case presented herein demonstrates the critical need for swift and decisive surgical exploration of patients with suspected embolisation of Celt ACD® devices in smaller distal arteries. Our experience has led to the recommendation that, due to the sharp edges of the Celt ACD® accompanied with the small diameter of the occluded vessels, surgical exposure and retrieval is the safest option if endovascular retrieval is unsuccessful.

Highlights

This report presents a case of surgical retrieval of a Celt ACD® vascular closure device (VCD) situated in the tibioperoneal trunk, following a failed attempt at deployment
Our experience has led to the recommendation that, due to the sharp edges of the Celt ACD® accompanied with the small diameter of the occluded vessels, surgical exposure and retrieval is the safest option if endovascular retrieval is unsuccessful
The use of vascular closure devices (VCDs) have become prominent in endovascular surgery. Their application has allowed for faster achievement of hemostasis at the access site, early recovery following intervention and early mobilization (Biancari et al 2010)

Summary

Conclusion

We strongly concur with Kalapatu et al that the site of occlusion dictates the method used for retrieval (Kalapatapu et al 2006). Recognition of device failure is crucial to prevent distal embolisation. Our recommendation on the management of embolised Celt ACD® devices in distal arteries is that open surgical retrieval remains the safest option if endovascular retrieval is unsuccessful. Endovascular retrieval of the device via a long guiding sheath is essential to avoid intimal injury if endovascular attempt was committed. Authors’ contributions QA and KQ participated in writing the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate Compliance with ethical standards. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Author details 1Vascular Surgery, Jordan University of Science and Technology, Irbid, Jordan. Author details 1Vascular Surgery, Jordan University of Science and Technology, Irbid, Jordan. 2Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan. 3King Abdullah University Hospital, Irbid, Jordan. 4Jordan University of Science and Technology, Irbid, Jordan

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