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In those patients who are anticoagulated, the success rate decreases to 62% from 73%. In addition, this technique is sometimes limited by the inability to apply adequate compression because of patient discomfort or because of the wide neck of the pseudoaneurysm. Stent-grafts have been used but are costly and not without their own complications. Perhaps a safer therapy for pseudoaneurysms that cannot be treated with compression is percutaneous thrombin injection (see Chap. 15). 2 Arterial Rupture One of the most dramatic and (fortunately) infrequent complications of angioplasty and stenting is arterial rupture.
This is popular with patients and staff. 2 Complications Various ingenious technological approaches have been developed. The Perclose device deploys a suture in the arterial wall to achieve haemostasis. The Angioseal consists of an external collagen plug as well as an absorbable polymer footplate which is deployed within the artery and held in place by a thread and a tensioning device. The Vasoseal and the Duett devices consist of a collagen plug which is deployed on the external surface of the arterial wall at the puncture site.
Arterial access via the upper limb is sometimes useful for renal artery or superior mesenteric artery procedures due to the downward slope of these vessels. 1 Axillary Historically axillary (or, more likely, high brachial) puncture was favoured because of its larger diameter compared with the brachial artery at the elbow or the radial artery. The axillary (high brachial) artery can be palpated with the arm externally rotated and abducted. The humeral head lies posteriorly, so some degree of compression can be achieved at the end of the procedure.