Can anyone shed some light on this complication after PCI?

[rouleaux82]

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I recently saw a pt who had a left heart cath (r-fem art approach) and began having claudication symptoms in this right calf soon after. He never had these sx before. The LHC showed minimal dx without any critical dx.

CTA of his R LE showed lesion in his popliteal artery--> they felt this may be a clot. Another percutaneous intervention was performed (L-fem art approach) and they found that it was NOT a clot and he actually had critical lesions in 3 vessels--> angioplasty was only partially successful. Stent was not attempted.

The thought now is that these lesions are from the 'foam' used during closure of his initial LHC that migrated distally causing these stenotic lesions. He is now being referred for vascular surgery consultation.

1. Has anyone experienced/managed this type of complication?

2. Is it common to have migration of the 'foam' used for closure?

 

[grendelsdragon]

I recently saw a pt who had a left heart cath (r-fem art approach) and began having claudication symptoms in this right calf soon after. He never had these sx before. The LHC showed minimal dx without any critical dx.

CTA of his R LE showed lesion in his popliteal artery--> they felt this may be a clot. Another percutaneous intervention was performed (L-fem art approach) and they found that it was NOT a clot and he actually had critical lesions in 3 vessels--> angioplasty was only partially successful. Stent was not attempted.

The thought now is that these lesions are from the 'foam' used during closure of his initial LHC that migrated distally causing these stenotic lesions. He is now being referred for vascular surgery consultation.

1. Has anyone experienced/managed this type of complication?

2. Is it common to have migration of the 'foam' used for closure?

1. I have not had this complication (thank God), but there was one case of embolization from a vascular closure device with one of my colleagues.

2. Not common. But, we use primarily the AngioSeal and Perclose-type vascular closure devices. That is to say, AngioSeal-type devices use a foot-plate anchor with a collagen plug, and Perclose-type devices use a suture knot. Perclose may fail, but they never embolize. AngioSeal anchors and/or collagen plugs can embolize, but it is very rare. If they do embolize, they are usually in one piece (unlike these "foam" closure devices, which we do not use).

In general, a good rule of thumb is to use these vascular closure devices judiciously. That is to say, don't use them if there is significant atherosclerosis/calcification in the puncture site. And when you use them, use it correctly. More often than not, failure is due to operator error.

 

[rouleaux82]

Interesting, thanks for the response!