Percutaneous Suture Mediated Closure Of Femoral Pseudoaneurysm
Karam Obeid, Nolan Mann, MD, Jonathan Parker, Michael Pham, MS, Samer Alharthi, MD MPH, David Dexter, MD, Animesh Rathore, MD, Jean Panneton.
Eastern Virginia Medical School, Norfolk, VA, USA.
DemographicsA 73-year-old Caucasian female and a 70 year old African-African female.History Patient 1 presents with a history of chronic congestive heart failure. She was found to have an asymptomatic 1.8 x 3.2 cm right femoral pseudoaneurysm - with a wide and short neck - and concomitant arteriovenous fistula secondary to cardiac catheterization. Patient 2 was found to have a left groin hematoma post lower extremity angiogram. A duplex study was performed which showed a 3.4 x 4.7 cm femoral pseudoaneurysm with a wide and short neck, no arteriovenous fistula and normal femoral vein hemodynamics. Both patients were not amenable to DDTI and were high risk for open surgery because of underlying comorbidities and anatomic constraints.PlanUnder moderate sedation, the contralateral common femoral artery was accessed to identify the exact location of the pseudoaneurysm via angiography. The pseudoaneurysm was then accessed with a micropuncture needle using ultrasound guidance directed into the pseudoaneurysm neck and native common femoral artery (fig 1). We exchanged the .018 inch microwire for a .035 inch Benston wire. Following the exchange, a Perclose ProGlide (Abbott Vascular, CA, USA) was advanced into the CFA and deployed to close the prior stick site. Completion angiography showed resolution of the psueodaneurysm. Duplex ultrasound on post-operative day 1 showed complete resolution of pseudoaneurysm in both patients and the AVF in patient 1. Both patients made uneventful recoveries.
DiscussionCommonly described technique for pseudoaneurysm includes Ultrasound Guided Compression, DDTI, or open surgery. We present a novel method of percutaneous closure of femoral pseudoaneurysm using Perclose ProGlide device. It avoids traditional wound complications commonly associated with open surgery and offers an attractive option for patients with contraindications against general anesthesia as it can be performed under moderate sedation. We propose that this technique can be applied to pseudoaneurysms with various anatomic variations including short neck, wide neck, high stick, and a large French size.
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