Novel Repair Technique for Iatrogenic Femoral Artery Pseudoaneurysms Using a Suture-Mediated Closure Device Combined With Bidirectional Guidewire Crossing: A Case Report

TL;DR

A new technique using a suture device and bidirectional guidewires successfully treated a difficult femoral artery pseudoaneurysm case.

Contribution

A novel bidirectional guidewire technique combined with a suture-mediated closure device for treating iatrogenic pseudoaneurysms.

Findings

Standard treatments like manual compression and thrombin injection failed in the patient's case.

The novel technique successfully closed the pseudoaneurysm as confirmed by angiography.

The approach may serve as an alternative for difficult cases requiring further evaluation.

Abstract

A novel approach for iatrogenic femoral artery pseudoaneurysm (IFAP) using a suture-mediated closure device and bidirectional guidewire percutaneously and intravascularly will be presented in this case report. We report a case of a 73-year-old male patient who faced a complication due to an IFAP following a percutaneous coronary intervention. Manual compression and thrombin injection combined with intravascular balloon inflation were not effective. We then inserted a guidewire percutaneously to use a suture-mediated closure device, but it could not pass through the pseudoaneurysm neck into the common femoral artery. We then attempted a novel technique involving bidirectional guidewire crossing to use the suture-mediated closure device. First, two guidewires were inserted into the pseudoaneurysm cavity percutaneously and intravascularly. Second, the intravascular guidewire was replaced with a snare using a microcatheter to catch the percutaneous guidewire and pull it through the pseudoaneurysm neck into the femoral artery. Third, the percutaneous guidewire was replaced with a 0.035 guidewire to use the suture-mediated closure device. Finally, we confirmed that the IFAP disappeared angiographically. Our new approach could be an alternative method for treating difficult cases. Additional studies may be required to evaluate the long-term safety and efficacy of this approach.

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