Managing Femoral Artery Pseudoaneurysm Using Snare-Guided Through-and-Through Access With Perclose ProGlide

Iatrogenic femoral artery pseudoaneurysm (IFAP) is a common complication following endovascular procedures. Treatment options include manual compression, ultrasound-guided compression, thrombin injection, and surgical repair, each with its own limitations. Recent case reports have described successful IFAP treatment using the Perclose ProGlide/ProStyle (Abbott Vascular, Lake Bluff, USA) suture-mediated closure device by directly puncturing the pseudoaneurysm sac and advancing a guidewire into the native artery. Herein, we present a novel through-and-through wire technique using the same device for treating IFAP. The technique involves advancing a microcatheter into the pseudoaneurysm from the contralateral femoral artery, deploying a snare through it, and then puncturing through the center of the deployed snare to establish through-and-through wire access for Perclose deployment. We successfully treated a 60-year-old woman who developed a femoral artery pseudoaneurysm following angiography. Compared to previously reported direct puncture techniques using Perclose, this approach allows real-time angiographic confirmation of device deployment and may reduce radiation exposure to operators compared with direct puncture techniques. While further experience is needed to determine its optimal role in clinical practice, this technique may serve as an effective alternative in the endovascular treatment of IFAP.