Delayed complication from a percutaneous vascular closure device following a neuro-interventional procedure

Area of Science:

• Interventional Cardiology
• Vascular Surgery
• Medical Device Safety

Background:

• Percutaneous vascular closure devices (PVCDs) offer advantages over manual compression for femoral arteriotomy closure after endovascular procedures, including reduced ambulation time, improved patient comfort, and cost savings.
• However, PVCDs are associated with complications such as hematoma, bleeding, arteriovenous fistula, pseudoaneurysm, and limb ischemia, typically occurring within 30 days post-procedure.

Observation:

• A 30-year-old male with a giant basilar trunk aneurysm underwent a procedure with bilateral femoral access, using 6 French Angio-Seals for closure.
• Ten months after the procedure, the patient developed a large right retroperitoneal iliopsoas hematoma after minor trauma, with no evidence of pseudoaneurysm.

Findings:

• This case represents the first reported instance of a delayed complication occurring ten months after percutaneous vascular closure device use.
• The patient was managed conservatively with stable hematocrit, avoiding surgical intervention.

Implications:

• Site-related complications associated with PVCDs can manifest in a delayed fashion, extending up to ten months post-procedure.
• Clinicians should consider the possibility of late-onset complications when managing patients who have undergone percutaneous vascular closure.
• This finding underscores the importance of continued vigilance and patient follow-up beyond the typical 30-day window for PVCD-related adverse events.