• Yasuhiro Aida, Kouichi Misaki, Tomoya Kamide, Masanao Mohri, Naoyuki Uchiyama, and Mitsutoshi Nakada.
• Division of Neuroscience, Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. Electronic address: aida@med.kanazawa-u.ac.jp.
• World Neurosurg. 2018 Mar 1; 111: e850-e855.

BackgroundFew studies have demonstrated detailed physical risk factors of hemorrhagic complications (HCs) associated with the Angio-Seal closure device. This retrospective study aimed to identify the risk factors of HC due to Angio-Seal use.MethodsData from 143 cases that underwent neurointerventional procedures that involved puncturing the femoral artery and that used an Angio-Seal to close the puncture site were reviewed. We divided these cases into HC and no HC groups and retrospectively compared age, sex, past medical and preference history, body mass index (BMI), femoral artery depth, dual antiplatelet therapy use, activated clotting time, general anesthesia use, sheath size, right femoral artery puncture, and treatment time.ResultsHC occurred in 7 cases, 2 of which were excluded because of technical failure. Accordingly, we examined physical risk factors in 5 cases (3.5%) in the HC group and in 136 cases (96.5%) in the no HC group. A low BMI and shallow femoral artery depth were significantly associated with HC, whereas the other factors were not. A receiver operating characteristic curve indicated that a BMI cut-off value of 20.98 and a femoral artery depth of 11.1 mm could achieve optimal diagnostic efficiency for predicting HC.ConclusionsPatients with a BMI <21 may require careful hemostasis monitoring, and it is better not to undergo arterial puncture site closure using Angio-Seal for those with a femoral artery depth <11.1 mm.Copyright © 2018 Elsevier Inc. All rights reserved.

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