Percutaneous transluminal angioplasty of suture-mediated closure device-related femoral artery stenosis or occlusive disease

This study evaluates the efficacy of percutaneous transluminal balloon angioplasty (PTA) to treat stenosis or occlusion following haemostasis using a suture-mediated closure (SMC) device. Steno-occlusion occurred in 7 (0.4%) patients, some with claudication, others without. Steno-occlusion was diagnosed immediately after haemostasis in the four patients without claudication, but diagnosis was delayed in all three patients with claudication. Six of the patients subsequently underwent PTA using a contralateral femoral arterial approach. Technical success, clinical response and vessel patency were evaluated retrospectively. Follow-up angiography revealed focal segmental steno-occlusion (<1 cm) in the common femoral or proximal superficial femoral artery in four patients and long segmental occlusion (>1 cm) in the external iliac and common femoral arteries in three patients. PTA was technically successful in all patients (6/6, 100%). Among the three patients who developed delayed onset of claudication, one declined treatment and the claudication improved in two. Doppler ultrasound obtained 28-129 days (mean; 75 days) after PTA revealed patent arterial flow in six patients. One patient with delayed-onset occlusion refused the procedure because the symptoms were mild. This study has shown that PTA is a useful treatment for steno-occlusion following haemostasis using the SMC device. Careful angiography and review of the femoral bifurcation prior to use of an SMC device is important.