Cutting Balloon Angioplasty for Superficial Femoral Artery Occlusion by a Suture Mediated Closure Device

Background Iatrogenic acute common femoral artery occlusion following suture-based percutaneous vascular occlusion devices (VCD) is a rare but limb-threatening complication needing immediate attention to prevent critical limb ischemia. The Perclose ProGlide (Abbott-Vascular, Redwood, California) is one such suture-based VCD that aims to mimic a surgical suture. Acute arterial occlusion following its use is rarely reported. Case Report We report a case of femoral artery occlusion caused by ProGlide by a ‘stitch’ of the anteroposterior vessel wall instead of the normal anterior wall puncture site. It was managed with a coronary cutting balloon and serial balloon dilatation to relieve the occlusion and restore antegrade flow, thereby avoiding a surgical repair. Result The antegrade flow was established both clinically and by the normal triphasic flow on Doppler ultrasonography with no residual ischemia after 18 months of follow-up. Conclusion Pathophysiology of vascular occlusion after suture-based VCD by a ‘stitch’ leading to tethering of the vessel wall needs to be understood. The use of a cutting balloon to transect the suture-based VCD to restore antegrade flow is a novel and viable option before open surgical relief and repair.