Percutaneous Vascular Closure Device-Related Complications with Emphasis on Delayed Malfunction

1. To review the differing types of percutaneous vascular closure devices available, their indications, mechanism of action, and technical considerations to ensure proper deployment.


2. To illustrate, through case-based review, the complications related to vascular closure device failure, with emphasis on delayed device malfunction.


3. To propose a simplified algorithmic approach to managing closure device-related complications.

Percutaneous vascular closure devices (VCDs) have become increasingly utilized with improved patient comfort and reduced time to hemostasis compared to manual compression following percutaneous arteriotomy. However, VCDs carry an additional inherent subset of complications related to foreign body deployment, deployment failure, and device malfunction. Device malfunctions typically occur within the peri-procedural period but can be delayed to 30 days post-procedure, after which patients may have already been discharged home. These complications are not benign and may cause major vascular complications leading to permanent adverse sequelae and largely affect patients’ quality of life and mobility.

Clinical Findings/Procedure Details:

Main types of VCDs include collagen-, sealant-, suture-, and clip-based devices. VCD-related complications include hematoma, active bleeding, arteriovenous fistula (AVF) formation, pseudoaneurysm, acute limb ischemia, infection, and deployment failure. Device malfunction typically occur in the peri-operative period but can extend to 30 days post-procedure, by which time collagen- and sealant-based plugs are resorbed. Treatment of these complications include conservative management, percutaneous intervention, and surgical repair.

Cases of VCD-related complications will be discussed. A delayed malfunction of suture-based VCD following endovascular stent graft exclusion of femoral-femoral AVF with resulting pseudoaneurysm which required open surgical repair. A 7-day delayed malfunction of collagen-based VCD following embolization for a large retroperitoneal hematoma with resulting pseudoaneurysm necessitating open surgical repair, complicated by rebleeding with surgical re-exploration, sartorius myoplasty, and prolonged negative pressure wound therapy of the groin.

Conclusion and/or Teaching Points:

Late vascular complications at the site of arteriotomy or continued blood loss despite transfusion of blood products should raise a high index of suspicion for delayed malfunction of VCDs. It is prudent for interventionalists to be aware of these complications and direct appropriate management.