{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:16:24Z","timestamp":1778145384030,"version":"3.51.4"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:00:00Z","timestamp":1777766400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To describe a novel technique for achieving reliable hemostasis after retrograde popliteal or proximal below-the-knee (BTK) arterial access, particularly in larger-profile interventions, through trans-sheath injection of a hemostatic matrix with thrombin to seal the percutaneous tract.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Technique:<\/jats:title>\n                    <jats:p>Following completion of the endovascular procedure, a guidewire is advanced from the antegrade femoral access across the retrograde puncture site, and an appropriately sized balloon catheter is positioned at this level. The retrograde sheath is gently withdrawn under aspiration until extraluminal placement is confirmed. The balloon is then inflated, and the hemostatic matrix with thrombin is injected through the sheath lumen to occlude the tract. After 3 minutes, angiography is performed to ensure complete hemostasis, vessel integrity, and preserved distal flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The method was applied in 21 consecutive cases (15 popliteal, 6 BTK) requiring access site \u2265 5F. Primary technical success was 95.2% (20\/21). In 1 patient, an additional 5 minutes of balloon compression was required. No secondary complications, including pseudoaneurysm, thrombosis, infection, or distal embolization, were observed during 30-day follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This closure strategy using trans-sheath delivery of hemostatic matrix with thrombin is feasible, safe, and reproducible, offering effective hemostasis after increased-bore retrograde popliteal or proximal BTK accesses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>This technique provides a reliable and reproducible solution for achieving hemostasis following retrograde popliteal and proximal below-the-knee arterial access, particularly in procedures requiring larger sheath sizes. By combining balloon occlusion with trans-sheath delivery of a hemostatic matrix containing thrombin, it minimizes the risk of access-site complications such as bleeding, pseudoaneurysm formation, and distal embolization. This approach may expand the safe use of retrograde access in complex peripheral interventions, reduce the need for prolonged manual compression or surgical repair, and improve overall procedural efficiency and patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028261434436","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:22:08Z","timestamp":1777872128000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Trans-Sheath Thrombin Injection to Achieve Hemostasis During Increased Bore Retrograde Accesses"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3550-7402","authenticated-orcid":false,"given":"Marta","family":"Lobato","sequence":"first","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario de Cruces, Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5519-3300","authenticated-orcid":false,"given":"August","family":"Ysa","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario de Cruces, Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amaia","family":"Arruabarrena","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario de Cruces, Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Carrascal","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario de Cruces, Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Gomez","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario de Cruces, Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Luis","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario de Cruces, Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1583\/08-2440.1"},{"issue":"3","key":"e_1_3_2_3_2","first-page":"781","article-title":"Retrograde popliteal artery access for femoropopliteal interventions in patients with chronic total occlusion","volume":"55","author":"Kawarada O","year":"2012","unstructured":"Kawarada O, Yokoi Y, Iwabuchi M, et al. Retrograde popliteal artery access for femoropopliteal interventions in patients with chronic total occlusion. J Vasc Surg. 2012;55(3):781\u2013788.","journal-title":"J Vasc Surg"},{"issue":"3","key":"e_1_3_2_4_2","first-page":"338","article-title":"Retrograde popliteal artery access in patients with femoropopliteal occlusive disease after failed antegrade access","volume":"20","author":"Bausback Y","year":"2013","unstructured":"Bausback Y, Willfort-Ehringer A, Perren F, et al. Retrograde popliteal artery access in patients with femoropopliteal occlusive disease after failed antegrade access. J Endovasc Ther. 2013;20(3):338\u2013343.","journal-title":"J Endovasc Ther"},{"issue":"1","key":"e_1_3_2_5_2","first-page":"76","article-title":"Popliteal artery access in the endovascular treatment of femoropopliteal occlusive disease: technical and clinical outcomes","volume":"23","author":"Stavroulakis K","year":"2016","unstructured":"Stavroulakis K, Torsello G, Schwindt A, et al. Popliteal artery access in the endovascular treatment of femoropopliteal occlusive disease: technical and clinical outcomes. 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