A Novel Endovascular Technique to Salvage Acute and Chronic Femoral Access False Aneurysms

Abstract

Purpose:

Femoral artery access site hemorrhage and false aneurysm, although infrequent, can have a significant impact on the morbidity and mortality of endovascular treatments. These complications are thought to occur in 2% to 7%. While most of them are minor, it is estimated that up to 10% can be severe and require open surgery. Management of acute and chronic false aneurysms include simple external compression, thrombin injection, covered stent placement and open surgical repair. We describe a novel endovascular technique to treat these complications with a minimally invasive percutaneous approach.

Technique:

A contralateral common femoral artery access is obtained and a crossover sheath is placed proximal to the bleeding site. The puncture site is accessed via a 4F catheter that is brought outside the artery in the subcutaneous tissue. A snare loop is advanced over the catheter and deployed; this serves as a target for a percutaneous puncture at the bleeding site. A 0.018-inch wire is then threaded into the needle and across the snare. It is caught and exteriorized from the contralateral sheath. A new sheath is advanced over this wire from the bleeding site and a new closure device is used to seal the artery.

Clinical Impact

The article’s clinical impact resides in the description of a novel technique using guidewire externalization to address femoral puncture site complications following endovascular procedures. The technique seems a feasible and useful solution to effectively treat bleeding and false aneurysms in a minimally invasive way.