Acute lower limb ischemia following Angio-Seal deployment after transfemoral percutaneous coronary intervention

Vascular closure devices (VCDs) have shown effectiveness in randomized trials and have been in clinical use for many years [1]. Their main advantage is in achieving complete hemostasis as effectively as classic manual compression, but within a significantly shorter period of time [2]. Taking into consideration hospital economics and patient comfort, the use of VCDs is also associated with a shorter immobilization period [2]. It is especially important in centers treating high numbers of patients and where patients are discharged shortly after a percutaneous procedure. However, some meta-analyses have raised doubts about the superiority of VCDs over manual compression (MC) in the case of serious complications [3]. We present a case of a patient with VCD complications, followed by a short literature review.
A 91-year-old woman with type 2 diabetes, chronic kidney disease, anemia, hypertension and peripheral artery disease (PAD) was admitted to hospital due to experiencing recurrent retrosternal pain for several days. An ECG showed ST segment depressions in lateral wall leads and elevated cardiac troponin levels.
She underwent urgent coronary angiography followed by angioplasty with zotarolimus-eluting stent implantation. The procedure was performed from the femoral approach with a good hemodynamic result. An Angio-Seal device was used to close the access site. The closure procedure was performed step-by-step, but complete hemostasis was not achieved. Due to active minor bleeding, manual compression and a pressure bandage were applied. After the procedure, the patient was in a good clinical condition and was observed overnight. Twelve hours of bed rest was recommended. The next morning, the patient reported a sudden loss of movement and numbness in the right foot. In the clinical examination, the right lower limb was cold and pale below the knee joint. The pulse was slightly palpable on the femoral artery and not palpable on the popliteal artery. Due to symptoms of acute limb ischemia, a computed tomography (CT) scan was performed. It revealed a critical occlusion in the right common femoral artery and relevant atherosclerotic stenosis in the distal part of the vessel (Fig. 1).
The patient underwent emergency thrombectomy. The surgeon found an intravascular component of the Angio-Seal blocking the deep femoral artery (Fig. 2). It was successfully removed and blood flow was restored. After surgery, signs of ischemia disappeared and the...


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