Steerable microcatheter-assisted selective inflow embolization of a giant femoral artery bifurcation pseudoaneurysm: A case report

Femoral artery pseudoaneurysm is a known complication of arterial access, and its management can be particularly challenging in patients with severe coagulopathy or complex vascular anatomy. Here, we report a case of a giant femoral artery bifurcation pseudoaneurysm arising from a long arterial sheath puncture tract at the bifurcation of the superficial and deep femoral arteries in a critically ill patient with septic shock and coagulopathy. Selective catheterization of the narrow, irregular tract was achieved using a steerable microcatheter with coordinated 2-operator manipulation under real-time fluoroscopic guidance. Subsequent selective inflow embolization using a limited volume of a N-butyl cyanoacrylate-Lipiodol mixture successfully occluded the pseudoaneurysm without distal ischemic complications. This case demonstrates that advanced microcatheter techniques can enable safe and effective endovascular treatment of complex femoral artery pseudoaneurysms in high-risk patients.