Percutaneous Endovascular Aneurysm Repair Complicated by Shallow Femoral Artery Access

TL;DR

A case report shows that very shallow femoral arteries can cause failure in percutaneous aneurysm repair, requiring surgical alternatives.

Contribution

Highlights shallow femoral artery depth as a previously under-recognized risk factor for percutaneous closure device failure.

Findings

An 82-year-old patient with shallow femoral arteries experienced bilateral hemostasis failure during PEVAR.

Computed tomography showed both common femoral arteries were only 3 mm beneath the skin.

The case suggests that CFA depth less than 8 mm may require surgical cutdown instead of percutaneous methods.

Abstract

Percutaneous endovascular aortic aneurysm repair (PEVAR) with vascular closure devices is widely used as an alternative to surgical cutdown. While predictors of access-related complications, such as common femoral artery (CFA) calcification and increased depth, have been reported, excessively shallow common femoral arteries are not well recognized as a risk factor. We report an 82-year-old emaciated male (height 168 cm, weight 43 kg, body mass index 15.2) with a rapidly enlarging abdominal aortic aneurysm who underwent PEVAR using the Perclose ProStyle device (Abbott Vascular, Inc., Redwood City, United States). Despite pre-placement of sutures, hemostasis failed bilaterally due to suture tracts traversing skin and subcutaneous tissue rather than advancing to the arterial wall, necessitating surgical cutdown and additional sutures to achieve hemostasis. Postoperative recovery was uneventful. Computed tomography revealed that both CFAs were located only 3 mm beneath the skin, suggesting that the posterior needle exit may have emerged extracorporeally, entrapping skin and subcutaneous tissue in the suture pathway. This case underscores that extremely superficial CFAs can predispose to failure of percutaneous closure devices. In patients with CFA depth less than 8 mm, operators should exercise caution, avoid excessive upward traction during needle advancement, and consider primary surgical cutdown as a safer alternative.

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