Up in Knots: A Case of Femoral Artery Wire Entrapment
Presenter
Nicolas B Krepostman, The University of Michigan, Ann Arbor, MI
Nicolas B Krepostman, The University of Michigan, Ann Arbor, MI
Keywords: Complications, Coronary and Vascular Access, Management, and Closure
Title
Up in Knots: A Case of Femoral Artery Wire Entrapment Introduction
Advancements in technique and device technology have significantly improved procedural outcomes and safety profiles in interventional cardiology; however, rare and unexpected complications can still occur. We present a unique case of guidewire entrapment in the femoral artery following coronary intervention, requiring retrieval with a snare device. This case highlights the complexity of managing device-related complications and the importance of creative approaches for vascular retrieval. Clinical Case
The patient is a 69-year-old man with coronary artery disease with prior stents to LAD and RCA who presented with CCS III angina and inferior/inferolateral ischemia on a nuclear SPECT. Due to prior unsuccessful attempts at radial angiography, coronary angiography was performed via ultrasound-guided access of the right femoral artery. There was significant iliofemoral tortuosity, and a 6Fr destination sheath was placed in the proximal descending aorta via a stiff 0.035” wire (Amplatz super stiff). His coronary angiogram revealed patent LAD and RCA stents, with 70% ISR of the proximal RCA stent and a de novo distal 70% stenosis (figures 1B, 1C). He underwent IVUS-guided PCI to the RCA with placement of two drug-eluting stents (figure 2). Following intervention, a suture-based closure device (Perclose Prostyle) was deployed over the stiff 0.035” wire. The suture knot was advanced to the arteriotomy with hemostasis; however, there was significant resistance on removal of the 0.035” wire. Fluoroscopy was notable for a knot in the 0.035” wire at the arteriotomy site (figure 3). Contralateral femoral access was obtained, and a 6 Fr IM catheter was used to access the right iliofemoral system. A 65 cm 5 Fr angle hydrophilic catheter (Glidecath) was advanced to the right common femoral. A stiff 0.035” wire was used to deliver a 55 cm 6Fr guiding sheath to the right external iliac. Angiography confirmed the intraluminal location of the knotted wire. With the assistance of vascular surgery, the wire was snared with a 35 mm 90° single loop snare (Medtronic Gooseneck snare). With countertraction, an 8F sheath was inserted into the right CFA over the entrapped wire, and after release of the snare, the knotted wire was removed (figures 4, 5, 6). Over a standard 0.035” wire, a second suture-based closure device was re-deployed with maintenance of hemostasis. Final lower extremity angiography revealed no evidence of vessel complication, and hemostasis was maintained. Discussion
Our case illustrates a rare complication of femoral artery wire entrapment that occurred during suture-based vascular closure following PCI. The case highlights the need for caution when using suture-based closure devices in complex peripheral anatomy and comfort with endovascular retrieval devices to facilitate creative solutions for entrapped equipment.