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CASE20191101_019
| ENDOVASCULAR - Complications | |
| Superficial Femoral Artery Pseudoaneurysm as a Delayed Complication of TurboHawk¢â Atherectomy | |
| Rebekah Li Wei Tan1, Kishore Sieunarine2 | |
| Hollywood Private Hospital, Australia1, Royal Perth Hospital, Australia2, | |
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[Clinical Information]
- Patient initials or identifier number:
T B
-Relevant clinical history and physical exam:
74 year old male, smoker, hypertension, ischaemic heart disease Progressive symptoms of left leg claudication despite being on best medical therapy. Warm feet, no tissue loss, delayed capillary refill in left foot. -Relevant test results prior to catheterization:
Left SFA 80% stenosis on CT angiography
Underwent percutaneous angiography Lesion crossed with guidewire Atherectomy performed with TurboHawk LX-C device followed by balloon angioplasty with a 5.0mm x 60mm drug eluting balloon. Completion angiogram showed satisfactory results with no dissection flap or contrast extravasation Patient discharged home, patient did not attend follow up appointment despite several reminders    - Relevant catheterization findings:
2.5 years later patient referred back to vascular surgeon by his cardiologist, with pain and mild swelling in the left thigh. CT angiography showed saccular aneurysm of the mid left SFA measuring 50x43x40 mm  |
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[Interventional Management]
- Procedural step:
7F sheath inserted via the right groin. Angiography confirmed mid left SFA saccular aneurysm where previous atherectomy was carried out. No other aneurysms identified. Fine wire used to cross lesion. Lesion stented with 6.0x60mm Viabahn stent (GORE, Flagstaff, AZ) and post dilated to 6mm. Completion angiogram showed successful exclusion of aneurysm. Puncture site closed with FemoSealDoppler ultrasound a month later showed SFA patency and thrombosed saccular aneurysm measuring 50x44x40mm with no endoleak.
   - Case Summary:
Aneurysm etiology: inadvertent atherectomy of disease free intima proximal and distal to target lesion ; Weakened arterial wall; High shear stress ; Tortuosity of treated vessel; Proximity to branch vessel; Proximity to prior surgical scar; Oversized atherectomy device Pseudoaneurysm after peripheral atherectomy is a complication associated with the procedure which must be followed up with repeat imaging. Development of symptoms such as limb pain, limb swelling, or increase in size of pseudoaneurysm should prompt timely assessment.Stenting of pseudoaneurysm secondary to peripheral atherectomy with a Viabahn stent is a viable and successful treatment option.
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