Author + information
- Apurva Patel1,
- Roosha Parikh1,
- Becky Naoulou1,
- Rahul Gokhroo1,
- Orkhan Guliyev2,
- Joseph Puma1 and
- Tak Kwan1
Pseudoaneurysm (PSA) is a rare complication (0.2%) after transpedal arterial access (TPA) for endovascular treatment of peripheral arterial disease, occurring only in the posterior tibial artery (PTA) likely related to the anatomy of the vessel giving unfavorable circumstances for adequate hemostasis. We describe a novel patent hemostasis protocol for TPA access to avoid PSA and pedal artery occlusion.
We prospectively studied 586 patients with symptomatic PAD who underwent 1038 peripheral procedures between 02/2016 and 02/2017 via TPA (dorsalis pedis artery (DP) /anterior tibial artery (ATA), PTA or peroneal artery (PA)). As per our new protocol, hemostasis for the DP/ATA was achieved with the VasostatTM device, while TR BandTM was used for PTA/PA (Figure). Patent hemostasis technique was confirmed using Doppler.
Of the 1038 procedures, 733 (88% interventional) were done via the DP/ATA, 176 (92% interventional) were done via the PTA and 129 (64% interventional) were via the PA. The incidence of PSA related to any access site was 0.0%. All access sites were patent on Doppler ultrasound at 30 day follow up.
PSA associated with TPA is very rare, it can be easily prevented with the above described patent hemostasis protocol while preserving the patency of the access site.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention