Mechanism and management of acute femoral artery occlusion caused by suture-mediated vascular closure device following neurointervention

Vascular closure devices (VCDs) show fewer complications related to the puncture site than manual compression but can cause stenosis or occlusion of the common femoral artery (CFA). A patient in her 30s who underwent suture-mediated VCD for haemostasis at the right CFA puncture site after neurointervention showed occlusion of the right CFA on postoperative day 2. Endovascular treatment retrieved the thrombus from the occlusion site, and surgical removal of a suture causing stenosis between the dissected posterior wall intima and anterior wall allowed the resumption of full flow through the right CFA. This complication occurred because the VCD insertion angle was less than 45 degrees, which allowed the footplate to deploy more perpendicularly, causing its posterior foot to snag and dissect the posterior wall intima. To mitigate the risk of such complications caused by the suture-mediated VCD, the surgeon should ensure that the entry angle of the puncture is not less than 45 degrees.