Case presentation
A 72-year-old man consulted our division because of femoral artery pseudoaneurysm. The patient had undergone endovascular treatment for left subclavian artery stenosis, for which the access site was the right femoral artery, four days before the consultation. Three days after the procedure, the patient complained of right lower quadrant pan, and a blood test showed a decreased hemoglobin (Hb) level from 12.9 to 9.0 g/dl. Computed tomography (CT) was then performed, revealing right-sided retroperitoneal hematoma extending from the right femoral access site, suggesting pseudoaneurysm with extravasation (Figure 1) (Online Video S1).
Although duplex echo-guided compression was performed, follow-up CT the next day showed worsening retroperitoneal hematoma and progression of anemia (Hb 7.2 g/dl). Therefore, the previous team consulted our division. Duplex echo (Video S2) showed a pseudoaneurysm 40 mm in diameter, with an aneurysmal neck continuing from the femoral artery at 6.1 mm in diameter (Figure 2). We diagnosed this case as complicated pseudoaneurysm with rupture.
Because there was no sign of infection, we decided to perform endovascular repair using a Perclose ProglideTM. To confirm the location of the pseudoaneurysm, we performed angiography using a contralateral femoral approach and punctured the pseudoaneurysm near the previously punctured skin mark under duplex echo guidance. Subsequently, a 0.035-inch guidewire was crossed to the right iliac artery through the aneurysmal neck (Video S3), and a 7-Fr sheath was inserted to facilitate closure device insertion. After retrieval of the 7-Fr sheath, the Perclose ProglideTM was tracked over the wire into the right femoral artery, and the foot was deployed at the appropriate position under fluoroscopy guidance (Figure 3ab, Video S4). Closure was then performed based on the appropriate position, and successful aneurysmal closure was confirmed by angiography (Figure 3c, Video S5, S6). The contralateral access site was also closed using the Perclose ProglideTM.
After the endovascular procedure, no recurrence of pseudoaneurysm was observed, and the patient was discharged on post-operative day 4.