Successful Stenting of Iatrogenic CFA Occlusion From Malpositioned Sutures of Perclose Device and Eight Year Follow up.

Background:
Stenting of arterial stenosis from suture mediated closure devices has not been well described in literature. Herein, we present a case of inadvertent iatrogenic common femoral artery stenosis secondary to malpositioned sutures of Perclose closure device, which was successfully managed with balloon expandable stenting with execllent clinical results at eight year follow up. A 56 year old lady with PMH of bicuspid aortic valve, AR, HTN, HLP, and PAD presented with worsening claudication in the left lower extremity. She was symptomatic on maximal medical therapy, had a claudication distance of 50 feet. ABI was 0.82 and waveforms demonstrated moderate aortoiliac/iliofemoral disease. An angiogram revealed 80% stenosis of the left common iliac artery and an occluded left internal iliac artery.

Methods:
She underwent PTCA with a 6-mm balloon followed by a 7 x 60mm BMS insertion, post dilated with 6.0 x 50 mm balloon, with excellent angiographic results. The femoral artery access site was sealed using perclose closure device. Post procedure she had excruciating pain, the popliteal artery was not palpable, a repeat ABI was 0.1, no flow was documented in the left common femoral artery. A repeat femoral angiogram confirmed occlusion of the common femoral artery at the prior access site caused from the suture of the perclose system. Femoral PTA was performed using the cross over technique, serial progressive dilatation using the non-compliant balloon was performed. A short multilink stent 5.0 x 12 mm was successfully inserted and post dilated to 14 atm with excellent angiographic results.

Results:
At 8 year follow up she continues to do clinically very well without any stent fracture and local complications from the CFA stenting.

Conclusions:
A recent publication has provided evidence that Endovasculra repair of the CFA seems to provide sustained clinical and morphological long term results. This supports further our successful management of iatrogenic CFA stenosis secondary to Perclose device suture malposition. Our case supported by the new emerging evidence in literature serves as a viable option for rescuing iatrogenic complete occlusion of the CFA from the malpositioned sutures of the perclose system.