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.