Abstract
Objectives: We considered the management how to avoid complications related to the femoral access after interventional radiology (IVR). Patients and Treatment: Between September 2009 and September 2011, local neurosurgeons referred to us 6 patients (4 males and 2 females) with a mean age of 67.5 years ranged from 15 to 87 due to the troubles at the femoral access after IVR for cerebral and cervical vessel lesions. Five patients underwent carotid artery stenting (CAS) and coil embolization for intracranial arteriovenous malformation was done in one patient. Pseudoaneurysms occurred with superficial femoral artery (SFA) puncture in 4 patients. Limb ischemia occurred in 2 patients. Their common femoral arteries were filled with thrombus and the vascular closure devices (Angio-SealTM SJM). Emergency operations were performed for these 6 patients including direct suture of puncture site in 3, angioplasty using autovein patch were done in 2 patients, and common femoral artery bypass using autovein graft was done in one patient. One patient suffered from fibral nerve palsy postoperatively. Conclusion: To avoid complications related to the femoral access, we must take care of the selection of the puncture site and the hemostasis as well as the endovascular catheter technique. Pre-operation mapping using ultrasonography and CT is useful to detect the accurate puncture site. Following catheter withdrawal, the manual compression required sustained pressure over the puncture site for at least 10–15 minutes. Vascular closure device (Angio-SealTM SJM) is restricted to the patient with proper indication. According to the individual cases, not only the percutaneus puncture but also the incisional open puncture might be considered.
