506 - Ultrasonography-Guided Suture-Mediated Vascular Closure (“Pseu-close” Technique) for Iatrogenic Femoral Artery Pseudoaneurysms

Purpose: Suture-mediated closure devices are widely used for managing large-bore arterial access sites. Their application to iatrogenic femoral artery pseudoaneurysms has been described, but most prior reports relied on angiography for lesion definition and wire guidance. This study evaluated the feasibility of performing the procedure solely under ultrasonography (US), particularly in situations where conventional options are limited or unsuitable.

Materials and Methods: Thirteen patients from three hospitals with iatrogenic femoral artery pseudoaneurysms were treated using suture-mediated closure devices (Perclose ProGlide or ProStyle; Abbott Vascular Devices) under real-time US. Doppler US characterized wall defects, neck morphology, and flow pattern. The procedure consisted of direct needle puncture/crossing of the pseudoaneurysm neck with a 21-G needle, followed by retrograde introduction of a microwire and microintroducer, and subsequent advancement of a 0.035-inch guidewire into the proximal artery, all under US guidance. The closure device was deployed with real-time visualization of the footplate against the arterial wall and assurance that the suture was correctly positioned within the lumen. Immediate completion Doppler US verified cessation of the yin–yang sign and flow stagnation within the sac.

Results: Technical success was achieved in all cases. Etiologies included complications after transcatheter valve implantation, coronary interventions, embolization, cerebral angiography, angioplasty, and dialysis catheter mis-implantation. Multiple devices were required in three patients (two devices in two, three devices in one), while one device sufficed in the remaining cases. Follow-up Doppler US demonstrates resolution of abnormal arterial flow and thrombus formation in all pseudoaneurysms. No major complications occurred.

Conclusion: US-guided suture-mediated vascular closure (“Pseu-close”) is a feasible method for iatrogenic femoral artery pseudoaneurysms, particularly when contrast is undesirable, when transfer to an angiography suite is not feasible, or when wide or short neck morphology makes thrombin unsuitable. The technique highlights the direct needle-tip approach under real-time US, which enables reliable passage through the pseudoaneurysm neck and ensures safe closure.

AI Disclosure Statement

During the preparation of this work, the authors used ChatGPT (GPT-5, OpenAI, 2025) to improve grammar and readability. The authors reviewed and edited the content and take full responsibility for the abstract.