Summary: Modern vascular closure devices (VCDs) like the Angioseal (Terumo; Tokyo, Japan) and Celt (Vasorum Ltd; Dublin, Ireland) offer rapid mechanical hemostasis of femoral arterial access sites. We recount a case wherein a Celt VCD was rigorously challenged to maintain hemostasis immediately after placement due to extenuating circumstances. The observed lack of consequent vascular complications provokes curiosity about held perceptions regarding achievement of hemostasis and time to ambulation following VCD placement for percutaneous femoral access.
A 70-year-old man with a history of hepatocellular carcinoma presented for planning hepatic angiography preceding repeat radioembolization. Given his history of recurrent deep vein thromboses, the patient was chronically anticoagulated on 5 mg Apixaban twice daily. It was strongly felt by his oncologist that anticoagulation should not be stopped for this procedure. Of note, pharmacologic anticoagulation was not discontinued for his previous planning angiogram or subsequent radioembolization. In both of those cases, the femoral access site was successfully closed with an Angioseal VCD (Terumo) without incident or complication.
Early in the angiography procedure, the patient’s blood pressure was noted to rise precipitously with systolic values reaching >190 mmHg. His blood pressure did not improve despite intravenous administration of 10 mg Hydralazine. It became evident that he was expending significant abdominopelvic effort in response to an urgent need to void. He declined usage of a bedpan and instead indicated strong preference to use a conventional bathroom near the angiography suite. The patient could not be compelled to reconsider this decision despite multiple attempts. Because arterial access had already been achieved, placement of a VCD was considered. Given the team’s capacity for continuous monitoring and the patient’s close proximity to the procedural suite, the treatment team felt confident that potential complications associated with closure device failure could be effectively managed if necessary. A Celt VCD was deployed at the puncture site, and hemostasis was confirmed.