Presentations

Abstract

Introduction: This case series details the novel use of the Perclose ProGlide closure device to successfully repair three separate cases of iatrogenic femoral pseudoaneurysms (PSAs), one of the most common complications following femoral arterial access. Conventional treatment methods of ultrasound-guided compression, duplex-directed thrombin injection (DDTI), or open surgical repair were contraindicated in these patients due to unique anatomy or advanced comorbidities.

Case Information: In the first case, a 73-year-old female had an access site PSA off the superficial femoral artery (SFA) with concomitant arteriovenous fistula (AVF) and advanced cardiac disease. The ProGlide device was deployed through the PSA neck with successful hemostasis. In the second case, a 78-year-old male had an asymptomatic access site PSA with a short and wide neck, as well as an endoleak following physician modified Thoracic Endovascular Aortic Repair (TEVAR). Access to repair the endoleak was obtained through the PSA neck. The ProGlide was successfully deployed following endoleak repair. In the third case, a 70-year-old female with chronic osteomyelitis of the left foot developed a left femoral PSA with a short and wide neck following bilateral lower extremity vascular interventions. The ProGlide was successfully deployed through the PSA neck, and the patient recovered well. All three patients maintained distal flow after ProGlide deployment.

Discussion/Clinical Findings: Conventional treatment methods for PSAs include ultrasound-guided compression, DDTI, and open surgical repair; however, these treatments may be inappropriate for patients with underlying comorbidities or complex anatomy. Ultrasound-guided compression has the disadvantage of being uncomfortable with moderate primary success rates. DDTI is limited by PSAs with larger diameters and wide necks. Open surgical repair comes with the added risk of poor wound healing or the physiologic burden of general anesthesia in critically ill patients. For these reasons, we describe our experience successfully using the ProGlide device to repair femoral PSAs with several anatomic variations, including short neck, wide neck, and concurrent AV fistula.

Conclusion: Further evaluation of the efficacy of the ProGlide device as a treatment modality for PSAs is required. This case series provides preliminary evidence supporting its potential as a modality to address iatrogenic femoral pseudoaneurysms.