The percutaneous femoral approach represents the most commonly used route for neuroendovascular procedures.
Its management is crucial to safe and procedure completion but also for the preservation of this route in the time of secondary artery puncture need.
Safeguard® 24 cm pressure assisted device has been developed for local hemostasis of the femoral artery after brief manual compression.
The use of an extracorporeal device, in comparison to the VCDs, could allow a greater flexibility when more sessions of femoral puncture are necessary.
Various vascular closure devices (VCDs) are available for local hemostasis after percutaneous transfemoral approach for neuroendovascular procedures but they have been associated with an increased complication rate and limitations to a re-puncture of the artery. We evaluated the safety and efficacy of Safeguard® 24 cm pressure assisted device (Merit Medical, West Jordan, UT, USA) and the associated complications.
From September 2016 to December 2019, 879 patients underwent neuroendovascular procedures via transfemoral approach using an introducer sheath ranging from 4 to 6-French and they were included in a prospective database. We registered the demographic characteristics and procedural factors. We evaluated the device failure and associated complications.
The Safeguard® was successful in 862 cases (98.1 %) with post-procedural local bleeding in 17 patients (1.9%). On univariate analysis, an association with local bleeding was observed with age >60 years (Odds ratio [OR] = 3.2, P = 0.04) and the use of an introducer sheath >4 F ([OR] = 3.1, P = 0.007). Female gender, antithrombotic medication and type of procedure (diagnostic or interventional) were not associated with local bleeding. On binary logistic regression analysis, there was association only for age >60 years ([OR] = 3, P = 0.04).
The Safeguard® 24 cm is safe and efficient. It is simple to use and it can be applied independently from vessel anatomic characteristics. It should though be used with caution in case of a femoral introducer sheath larger than 4 Fr and patients older than 60 years.Le texte complet de cet article est disponible en PDF.
Keywords : Percutaneous transfemoral approach, Various vascular closer devices, Safeguard® 24 cm, Local hemostasis, Neuroendovascular