The management of peripheral vascular complications associated with the use of percutaneous suture-mediated closure devices

Purpose: The purpose of this study is to identify the peripheral vascular c omplications associated with the use of percutaneous suture-mediated closur e (PSMC) devices and compare them with postcatheterization femoral artery c omplications not associated with PSMC devices. Methods: This is a retrospective review of all patients admitted to the vas cular surgery service at the Chattanooga Unit of the University of Tennesse e Department of Surgery with a peripheral vascular complication after percu taneous femoral arteriotomy between July 1, 1998, and December 1, 1999. The complications followed the use of PSMC devices (group I, n = 11) and tradi tional compression therapy (group II, n = 14) to achieve arterial hemostasi s. Group II was subdivided into patients who required operative interventio n (group IIA, n = 8), and those who were treated without operation (group I IB, n = 6). Results: No significant difference was found between groups I and II with r egard to age (P = .227), time to vascular surgery consultation (P = .987), or diagnostic versus therapeutic catheterization (P = .897). A significant difference was found with regard to mean pseudoaneurysm size (group I = 5.9 cm, group II 2.9 cm; P = .003). Ultrasound compression was successfully pe rformed in 66.6% of group 11 patients, but no (0.0%) patient in group I res ponded to this therapy (P = .016). Groups I and IIA had a significant diffe rence for mean estimated blood loss (group I = 377.2 mL, group II = 121.8 m L; P = .017) and requirement for transfusion (P = .013). More patients in g roup I required extensive surgical treatment (P = .007), with six of these patients requiring vein patch angioplasty during their treatment. More pati ents in group I also had infectious complications (n = 3) compared with gro up IIA (n = 1). Conclusion: In comparison with complications that follow percutaneous arter iotomy when PSMC devices are not used for hemostasis: (1) pseudoaneurysms a fter the use of PSMC devices are larger and do not respond to ultrasound co mpression, (2) complications associated with PSMC devices result in more bl ood loss and increased need for transfusion and are more likely to require extensive operative procedures, and (3) arterial infections after the use o f PSMC devices are more common and require aggressive surgical management.