J Korean Soc Radiol.  2017 May;76(5):326-332. 10.3348/jksr.2017.76.5.326.

Morphologic Features of Puncture Sites after ExoSeal Vascular Closure Device Implantation: Changes on Follow-Up Computed Tomography

• Ryu H
• Jang JY
• Kim TU
• Lee JW
• Park JH
• Choo KS
• Cho M
• Yoon KT
• Hong YM
• Jeon UB

• KMID: 2377035
• DOI: http://doi.org/10.3348/jksr.2017.76.5.326

Abstract

PURPOSE
The study aimed to evaluate the morphologic changes in transarterial chemoembolization (TACE) puncture sites implanted with an ExoSeal vascular closure device (VCD) using follow-up computed tomography (CT).
MATERIALS AND METHODS
16 patients who used ExoSeal VCD after TACE were enrolled. Using CT images, the diameters and anterior wall thicknesses of the puncture sites in the common femoral artery (CFA) were compared with those of the contralateral CFA before TACE, at 1 month after every TACE session, and at the final follow-up period. The rates of complications were also evaluated.
RESULTS
There were no puncture- or VCD-related complications. Follow-up CT images of the CFA's of patients who used ExoSeal VCDs showed eccentric vascular wall thickening with soft-tissue densities considered to be hemostatic plugs. Final follow-up CT images (mean, 616 days; range, 95-1106 days) revealed partial or complete resorption of the hemostatic plugs. The CFA puncture site diameters did not differ statistically from those of the contralateral CFA on the final follow-up CT (p > 0.05), regardless of the number of VCDs used.
CONCLUSION
Follow-up CT images of patients who used ExoSeal VCDs showed no significant vascular stenosis or significant vessel wall thickening.

MeSH Terms

Chemoembolization, Therapeutic
Constriction, Pathologic
Femoral Artery
Follow-Up Studies*
Humans
Punctures*
Tomography Scanners, X-Ray Computed
Vascular Closure Devices*

Figure

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  Fig. 1 Inclusion criteria. CT = computed tomography, TACE = transarterial chemoembolization, VCD = vascular closure device

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  Fig. 2 A 59-year-old female patient (patient #4) underwent TACE for HCC, and after the procedure ExoSeal was applied in the right CFA. The second TACE was performed after 3 months of follow-up. At that time, the puncture site was closed using simple manual compression. A. Preprocedural CT demostrates two patent CFAs with no wall thickening. B. One-month follow-up CT shows eccentric wall thickening with soft-tissue density (white arrow) at the puncture site. C. Seven-month follow-up CT demostrates disappearance of the soft-tissue density during the follow-up period. CFA = common femoral artery, CT = computed tomography, HCC = hepatocellular carcinoma, TACE = transarterial chemoembolization

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