SIR 2024
Arterial Interventions and Peripheral Arterial Disease (PAD)
Emidio Tarulli, MD, RPVI
Interventional Radiologist
Queen's University, Canada
Financial relationships: Full list of relationships is listed on the CME information page.
Alexandre Menard, MD
Interventional Radiologist
Queen's University, Canada
Disclosure information not submitted.
Amir Reza Nasirzadeh, MD
Interventional Radiologist
Queen's University, Canada
Disclosure information not submitted.
Ben Mussari, MD
Interventional Radiologist
Queen's University, Canada
Disclosure information not submitted.
Demonstrate the retrograde approach of treating femoral arterial pseudoanuerysms with a vascular closure device.
Background:
Femoral artery pseudoaneurysms (PSAs) are recognized complications following angiography and percutaneous interventions. A PSA is defined as a contained rupture of an artery into the surrounding connective tissue lacking a true fibrous wall {1}. Overall incidence for these complications ranges from 0.2 to 7% {2}. Despite the relatively low incidence, the high number of arterial catheterization procedures performed makes this a prevalent complication {Morgan}. Established methods for treating PSAs include surgical repair{3}, ultrasound-guided compression{4}, selective embolization of the PSA neck using n-butyl cyanoacrylate{5}, stent graft deployment{6}, coil embolization{7}, and direct thrombin injection{8}. Recent case reports demonstrate treating PSAs using vascular closure devices from an antegrade puncture of the PSA {9}. However, if the PSA sac/neck anatomy is complex navigating from the sac through the neck into the native artery can be challenging or impossible with a risk of sac rupture during puncture and manipulation.
This educational exhibit presents a retrograde technique of femoral artery PSA repair from the native artery through the PSA neck with deployment of an Angio-Seal (St Jude Medical, St Paul, MN, USA) vascular closure device.
Clinical Findings/Procedure Details:
First, contralateral percutaneous access is obtained and a directional diagnostic catheter is advanced to the neck of the PSA with angiograms performed to delineate the anatomy of the PSA sac and neck. Through and through wire access is then established in one of two ways:
1. Fluoroscopic guided micro puncture through the sac to the lumen of the directional catheter; "eye of the tiger" method.
2. Directing a wire into the PSA sac from the catheter and snaring the wire from within the sac; "go fish" method.
Once wire access is established through the sac and neck, an Angioseal Vascular closure device is deployed as per IFU. A completion angiogram is performed to demonstrate effective treatment of the PSA.
Conclusion and/or Teaching Points:
The retrograde technique of closing a femoral arterial pseudoanuerysm is a useful approach for treating complex PSA neck anatomies that are not amenable to ultrasound thrombin injection and avoids the use of a covered stent or open surgical repair.