case_images: PMC10559466_01
case_images: A 72-year-old lady who underwent right leg thrombolysis (a) Common femoral artery access site with calcified atherosclerotic plaques on anterior and posterior walls. (b) Embolized footplate seen as echogenic structure (Yellow arrow) within the popliteal artery stent with acute thrombosis. (c) Right leg angiogram showing complete thrombosis of popliteal artery stent. (d) Post 24-h thrombolysis resolution of thrombus with filling defect (red arrow). (e) Post-stenting angiogram showing good flow across the popliteal artery with no stenosis. (f) Distal right leg angiogram showing good flow to foot through posterior tibial and peroneal arteries. The anterior tibial artery is chronically occluded.
case_images: JCIS-13-26-g001.jpg
case_images: PMC10559466_01_JCIS-13-26-g001.jpg
case_images: F1
case_images: A 6 Fr Angio-Seal was used for access site closure [Figure 1a shows right CFA access site with calcified plaques] and she was discharged. An ultrasound Doppler revealed embolized footplate of Angio-Seal trapped in the popliteal artery stent with thrombosis [Figure 1b]. Supera (Abbott Vascular, Chicago, USA) stent 5.5 mm x 40 mm was placed [Figure 1c-f]. She was restarted on aspirin and apixaban, clopidogrel was also added for 3 months.
case_images: A 72-year-old woman who underwent right leg thrombolysis developed rethrombosis due to embolized footplate which was managed with endovascular intervention. Follow-up imaging (a) Computed tomography angiogram showing patent right popliteal artery stents. (b) Ultrasound Doppler showing good flow across the right popliteal artery stent with no in-stent stenosis.
case_images: JCIS-13-26-g002.jpg
case_images: PMC10559466_01_JCIS-13-26-g002.jpg
case_images: F2
case_images: Follow-up at 6 weeks and 6 months has been done; she is asymptomatic with patent right popliteal artery stents [Figure 2].
case_images: PMC10559466_02
case_images: A 62-year-old man underwent bilateral iliac stenting and had left access site arterial occlusion following Angio-Seal deployment (a). Left leg angiogram showing filling defect in the proximal superficial femoral artery (Red arrow). (b). Post-stenting (6 mm x 50 mm) angiogram showing good flow across the proximal superficial femoral artery. (c). Follow-up ultrasound Doppler at 3 months showing patent stent with good flow, the hypoechoic area possibly represents fibrotic reaction to the Angio-Seal device components.
case_images: JCIS-13-26-g003.jpg
case_images: PMC10559466_02_JCIS-13-26-g003.jpg
case_images: F3
case_images: A 6 Fr antegrade access of the left common femoral artery (CFA) was taken and the narrowing could be crossed with a guidewire, angioplasty with 6 mm balloon was not successful; hence, a Viabahn (GORE, Newark, USA) 6 mm x 50 mm stent graft was placed across the narrowing with good result [Figure 3]. A follow-up ultrasound Doppler after 3 months revealed patent iliac and left SFA stents with resolution of clinical symptoms.
case_images: PMC10559466_03
case_images: A 63-year-old woman developed right common femoral arterial occlusion following Angio-Seal deployment (a and b) Right leg computed tomography angiogram showing focal occlusion (Red circle) in common femoral artery (CFA). (c and d) Surgical endarterectomy (Yellow arrow) and retrieval of the Angio-Seal device. (e) Follow-up ultrasound Doppler showing patent right CFA with good flow.
case_images: JCIS-13-26-g004.jpg
case_images: PMC10559466_03_JCIS-13-26-g004.jpg
case_images: F4
case_images: CT angiogram revealed occlusion in the right CFA at the access site [Figure 4a and b]. She was taken for an urgent surgical endarterectomy and the footplate was retrieved from the CFA [Figure 4c and d]. Follow up color Doppler ultrasound revealed good flow across the common femoral artery [Figure 4e].
case_images: PMC10559466_04
case_images: A 66-year-old woman underwent right leg angioplasty and developed common femoral artery (CFA) pseudoaneurysm. (a) Right leg angiogram showing patent superficial femoral artery origin. (b) Post-angioplasty ultrasound (US) Doppler revealed pseudoaneurysm arising from the CFA. (c) Thrombosed pseudoaneurysm following US-guided thrombin injection. (d) Computed tomography angiogram showing resolution of pseudoaneurysm with occlusion at previously patent superficial femoral artery origin (Yellow arrow).
case_images: JCIS-13-26-g005.jpg
case_images: PMC10559466_04_JCIS-13-26-g005.jpg
case_images: F5
case_images: A 66-year-old lady with multiple comorbidities - dementia, diabetes, hypertension, and chronic kidney disease -underwent successful angioplasty of the right leg [Figure 5a] for an infected foot ulcer. The pseudoaneurysm was treated with ultrasound-guided percutaneous thrombin injection [Figure 5b and c] and an angioplasty was planned for the proximal SFA stenosis [Figure 5d] considering her multiple comorbidities; however, she succumbed to severe lower gastrointestinal hemorrhage before the repeat angioplasty.