Real-World Outcomes of Immediate Femoral Sheath Removal After Emergency Embolization in the Age of Ultrasound-Guided Device-Assisted Vascular Closure

Q: What was the main purpose of the study?

To evaluate the safety and efficacy of immediate femoral sheath removal after emergency arterial embolization, focusing on reintervention and access site complications.

Q: How were reintervention and complications defined?

Reintervention was repeat embolization within 7 days, and access site complications were tracked following the procedure.

Q: What factors were associated with higher access site complication risk?

Pre-procedural platelet level ≤80×10^9/L and INR >1.5 were associated with complications, and platelets ≤80×10^9/L was the strongest independent predictor on multivariate analysis.

Sep 30, 2026

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Emergency arterial embolization is a life-saving procedure usually performed through femoral access. This retrospective cohort study assessed the safety and effectiveness of immediate femoral sheath removal after emergency embolization at a level 1 trauma center (January 2022–May 2025). Among 322 procedures in 299 adults, reintervention occurred in 4.0% and access site complications in 6.2% (major 0.9%). Platelet counts ≤80×109/L and elevated INR were linked to complications, while thrombocytopenia was the strongest independent predictor; a VCD choice also predicted outcomes. Immediate removal was generally safe, but risk-stratified delayed removal may be warranted for low platelets.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

Introduction

Emergency embolization via femoral access

Immediate vs delayed sheath removal

Role of vascular closure devices

Materials and Methods

Article Real-World Outcomes of Immediate Femoral Sheath Removal After Emergency Embolization in the Age of Ultrasound-Guided Device-Assisted Vascular Closure Terrence Hui 1,2, *, Akshay Kohli 2, Ross Copping 2,3, Hannah Ireland 2, Shady Osman 2, Bryan Barry 2, Jules Catt 2 and Glen Schlaphoff 2 Academic Editors: Francesco Giurazza and Fabio Corvino Received: 2 December 2025 Revised: 17 December 2025 Accepted: 18 December 2025 Published: 22 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore 2 Department of Interventional Radiology, Liverpool Hospital, Liverpool, NSW 2170, Australia; [akshayk.livrad@gmail.com](akshayk.livrad@gmail.com) (A.K.); [ross.copping@health.nsw.gov.au](ross.copping@health.nsw.gov.au) (R.C.); [hannah.ireland1@health.nsw.gov.au](hannah.ireland1@health.nsw.gov.au) (H.I.); [shady.osman@health.nsw.gov.au](shady.osman@health.nsw.gov.au) (S.O.); [bryan.barry@health.nsw.gov.au](bryan.barry@health.nsw.gov.au) (B.B.); [jules.catt@health.nsw.gov.au](jules.catt@health.nsw.gov.au) (J.C.); [glen.schlaphoff@health.nsw.gov.au](glen.schlaphoff@health.nsw.gov.au) (G.S.) 3 Discipline of Medicine, UNSW Medicine and Health, Sydney, NSW 2052, Australia * Correspondence: [dr.terrencehui@gmail.com](dr.terrencehui@gmail.com); Tel.: +65-62566011 Abstract Background/Objectives: Emergency arterial embolization is a life-saving procedure typically performed via femoral access. This study evaluated the safety and efficacy of immediate femoral sheath removal following emergency embolization. Methods: A retrospective cohort study was conducted at a Level 1 trauma center (January 2022–May 2025) . Adult patients undergoing emergency embolization with immediate sheath removal were included. Endpoints were reintervention (repeat embolization within 7 days) and access site complications. Multivariate logistic regression identified independent predictors of outcomes. Results: A total of 322 emergency embolization procedures in 299 patients were included. The most common indication was gastrointestinal hemorrhage (45.7%) . Vascular closure devices (VCDs) were used in 92.5% of cases. The re-intervention rate was 4.0%(13/322) . The overall access site complication rate was 6.2%(20/322), with a major complication rate of 0.9%(3/322) . On univariate analysis, pre-procedural platelet level ≤ 80 × 109/L (p = 0.034) and INR > 1.5 (p = 0.034) were significantly associated with an increased risk of complications. On multivariate analysis, pre-procedural platelets ≤ 80 × 109/L was the strongest independent predictor of access site complications (OR 7.28, 95% CI 1.51–35.12; p = 0.013) . Choice of vascular closure device was an independent predictor for both reintervention and complications (p < 0.05), likely reflecting bias. Conclusions: Immediate femoral sheath removal following emergency embolization is safe for most patients. However, thrombocytopenia is a significant risk factor for access site complications. A risk-stratified approach with consideration for delayed sheath removal is warranted for patients with platelet counts ≤ 80 × 109/L. Keywords: access site complications; emergency embolization; endovascular; trauma; vascular closure device 1. Introduction Emergency arterial embolization is a minimally invasive, life-saving procedure performed by Interventional Radiologists for controlling acute haemorrhage [1–10] . This technique is an important alternative to emergency surgery for various clinical scenarios such as acute gastrointestinal bleeding and solid organ injury, and the common femoral artery (CFA) is often used as the site of primary vascular access [9–14] . While immediate sheath removal is standard practice in elective cases, the practice in em

FAQs

What was the main purpose of the study?

To evaluate the safety and efficacy of immediate femoral sheath removal after emergency arterial embolization, focusing on reintervention and access site complications.

How were reintervention and complications defined?

Reintervention was repeat embolization within 7 days, and access site complications were tracked following the procedure.

What factors were associated with higher access site complication risk?

Pre-procedural platelet level ≤80×10^9/L and INR >1.5 were associated with complications, and platelets ≤80×10^9/L was the strongest independent predictor on multivariate analysis.

Sep 30, 2026

Upload by Callum