Fluoroscopic Guided Fogarty Embolectomy for an Angio-Seal Embolism in the Popliteal Artery
A 47-year-old man underwent percutaneous coronary intervention (PCI) secondary to unstable angina. The right common femoral arterial puncture site was closed with an Angio-Seal. There was no definite immediate complication, and the patient was discharged from the hospital.\nTwo days after the PCI, he presented pain and numbness of the right calf. Symptoms were progressively aggravated in the following week. He revisited the hospital eight days after the procedure. Upon physical examination, there was no evidence of hematoma or pseudoaneurysm at the puncture site. Ultrasonography showed presumed aggregated collagen with bright echogenic anchor of the Angio-Seal device in the right popliteal artery ().\nA left femoral artery puncture was made, and right lower extremity angiography was performed with a 5 Fr catheter. Total occlusion of the distal popliteal artery was observed in angiography (). Correlating with ultrasonography, a right popliteal artery occlusion due to the Angio-Seal that had broken away from its original location was diagnosed. The arteries distal to the occlusion were reconstituted by collateral vessels, showing reduced but persistent lumens.\nUnder local anesthesia, the right common femoral artery was exposed by a cardiothoracic surgeon. An 8 Fr long vascular sheath was inserted antegrade into the right superficial femoral artery. A 4 Fr Fogarty balloon catheter (Edwards Lifesciences, Irvine, CA, USA) was introduced into the vascular sheath, then inserted into the arterial lumen until the balloon was located distal to the embolus over an 0.018 wire (Terumo, Tokyo, Japan). The balloon of the Fogarty catheter was inflated and pulled back toward the femoral artery cutdown site (). While performing the procedure, we could recognize the location of the embolus in angiography, which was seen as a filling defect between the balloon. Contrast was made by injecting a small amount of contrast material through the sheath (). The embolus was successfully removed through the incision site of the femoral artery. It consisted of the Angio-Seal sponge with anchor, and had accumulation of acute thrombus proximally ().\nAfter a 12-month follow-up, the patient was pain free, and his post-interventional course was uneventful.