Iatrogenic vascular injuries from percutaneous vascular suturing devices

Objective: The purpose of this study was to examine the patterns of injury and the strategies of surgical repair of iatrogenic vascular injuries from a percutaneous vascular suturing device after arterial cannulation. Methods: We retrospectively reviewed the clinical experience from an academ ic vascular surgical practice over a 2-year period. The subjects were patie nts undergoing vascular repair of iatrogenic vascular injury after deployme nt of a percutaneous vascular suturing device. Interventions were direct re pair of arterial injury (with or without device extraction) or arterial thr ombectomy and repair. The main outcome variables included patterns of arter ial injury magnitude of arterial repair, limb salvage, hospital stay, and p erioperative mortality and morbidity rates. Results: From August 1998 through August 2000, eight patients (4 men, 4 wom en; median age, 55 years; range, 44-80 years) required vascular operations for complications of percutaneous suturing devices after diagnostic (2) or therapeutic (6) arteriograms through a transfemoral approach. Complications included four pseudoaneurysms (1 infected) due to arterial tear from sutur e pull through, two entrapped closure devices due to device malfunction, an d two arterial thromboses due to narrowing/severe intimal dissection. All p atients required operative intervention. Direct suture repair with or witho ut device removal was performed in five patients, arterial debridement with vein patch angioplasty in one patient, and arterial thrombectomy and vein patch angioplasty in two patients. There were no perioperative deaths. The median hospital stay was 5 days (range, 2-33). Limbs were salvaged in all p atients with a mean follow-up of 4.8 months (range, 1-13). Conclusions Although abbreviated postangiography recovery periods and early ambulation have motivated the widespread use of percutaneous suturing devi ces, the infrequent occurrence of vascular injuries produced by these devic es can be significantly more challenging than simple acute pseudoaneurysms or hemorrhage. In addition, thrombotic complications have a small but finit e risk of limb loss.