Abstract 1960: Conservative vs. Interventional Treatment of Angio-Seal-Induced Femoral Artery Stenoses Complicating Coronary Angiography
Objective: The Angio-Seal haemostatic puncture closure device is commonly used to minimize vascular complications at the puncture site after coronary angiography. It may induce femoral artery stenosis. The objective of this study was to compare conservative and interventional treatment of Angio-Seal induced femoral artery stenoses.
Methods: In 13 (9 male) of 1605 (0.8%) patients treated with Angio-Seal after coronary angiography a femoral artery stenosis was diagnosed. In all patients there was no history of PAOD. The lesions were located in the common femoral artery (n = 3) or superficial femoral artery (n = 10). Asymptomatic patients (n = 5, group A) were treated conservative and symptomatic patients were treated interventionally (group B). Mean grade of stenosis was 78 ± 9.1% (group A) and 92 ± 6.8% (group B), respectively. Walking capacity (120 ± 46.9m vs. 60 ± 16.9m) and ankle-brachial-Index (ABI) at rest (0.61 ± 0.14 vs. 0.48 ± 0.11) were significantly reduced in group B (p < 0.001). In group B a total number of 6 self-expandable nitinol stents (mean length 47.2 ± 16.9mm) were implanted, 2 patients were treated only by single PTA, in 1 patient additional local thrombolysis was performed.
Results: in group B a primary technical success without residual stenosis could be achieved in all patients (100%). Serious complications at the puncture site related to the PTA and stent implantation did not occur. To assess the long-term results, clinical follow-up examinations were performed regularly in both groups. Mean follow-up was 21.2 (range 13 to 29) months. At latest follow up all patients of group A were asymptomatic, walking capacity and mean ABI remained stable at 167 ± 62.4m and 0.53 ± 0.1, respectively (p = n.s.). In group B the walking capacity and ABI had increased significantly (222 ± 27.8m and 0.94 ± 0.1 (p < 0.001)). At follow-up the primary patency rate was 87.5% in group B. In B one restenosis could be successfully treated by repeat PTA leading to an assisted primary patency of 100%.
Conclusion: By implantation of self-expanding stents symptomatic Angio-Seal-induced femoral artery stenoses can be treated successfully showing a long-term patency that is considerably high. Asymptomatic Angio-Seal-induced femoral artery stenoses might be treated conservatively.