Two Different Approaches for Closure of Iatrogenic Femoral Pseudoaneurysms Using a Closure Device

Iatrogenic pseudoaneurysms at vascular access sites are a common complication of endovascular procedures, occurring in 2.6%-7.7% of femoral artery access cases. Conventional treatments, such as manual compression, thrombin injection, surgical repair, and stent graft placement, each present limitations, including recurrence, invasiveness, and embolic risk. Recently, suture-mediated closure devices have emerged as minimally invasive and promising alternatives for pseudoaneurysm repair. We successfully treated two pseudoaneurysms, one involving the superficial femoral artery (SFA) and another involving the common femoral artery (CFA), using the Perclose ProStyle closure device (Abbott, Santa Clara, CA, USA). Case 1 involved an 86-year-old man who developed a left SFA pseudoaneurysm following intra-aortic balloon pump therapy. Angiography and ultrasonography confirmed the diagnosis. A guidewire was introduced from the contralateral CFA to the pseudoaneurysmal neck, advanced into the cavity, and retrieved by direct puncture. The pseudoaneurysm was repaired using the Perclose ProStyle. Case 2 involved an 82-year-old man who developed a CFA pseudoaneurysm after percutaneous thrombectomy for acute leg ischemia. Due to the proximal extension and limited cavity size, a direct puncture technique, from the distal skin to the pseudoaneurysmal neck, was employed under ultrasound guidance. Suture-mediated closure is a promising, minimally invasive technique that averts complications, including infection, thrombosis, and prolonged recovery, associated with traditional treatments. This method can be adapted based on pseudoaneurysm size and location, enhancing its clinical applicability. These cases demonstrate the feasibility of different closure device techniques, suggesting their potential for broader adoption in pseudoaneurysm management.