Successful conservative treatment of right common femoral artery dissection after closure with an Angio-SealTM device

A 49-year-old male patient was subjected to coronarography due to stable angina. Percutaneous coronary intervention of the right coronary artery with multiple stent implantations was performed. After the procedure, the 6 F sheath from right common femoral artery was removed using a collagen-based Angio-SealTM closure device. The patient complained of temporary pain in the right groin after the procedure. He was discharged from hospital the next day. Immediately after the discharge, the patient noticed symptoms of intermittent claudication at a distance of 50–100 m. The patient was admitted to the vascular surgery ward where angio-computed tomography (CT) confirmed the right common femoral artery stenosis (Fig. 1). An ultrasound examination of the right femoral artery revealed severe stenosis of the vessel with the dissection of posterior wall that was caused by the bioabsorbable anchor of the closure device (Figs. 2, 3). Because of the recent multiple coronary stent implantations and dual antiplatelet therapy, the patient was discharged without surgery. Treatment of enoxaparin sodium in therapeutic doses was introduced. Over the next 4 months, the distance of intermittent claudication gradually increased. In subsequent ultrasound examinations, the grade of the stenosis was smaller, and after 4 months, the flow was normalised and the symptoms had spontaneously completely resolved (Fig. 4) According to the manufacturer, all of the components of the device (suture, collagen and anchor) are bioabsorbed within 60 to 90 days. Management of such complications is not well established. Surgical arteriotomy, endarterectomy and thrombectomy in the case of concomitant thrombus and reconstructions are being performed. This case shows that conservative treatment with watchful observation might be an option.