Today’s case 4 – Iatrogenic bleeding of deep femoral artery while insertion of A-line

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Iatrogenic bleeding of deep femoral artery while insertion of A-line

Iatrogenic bleeding of deep femoral artery while insertion of A-line
During the insertion of the A-line, an iatrogenic active bleeding occurred as a result of puncturing the Right Deep Femoral Artery (DFA). Given that the DFA bleeding is located just below the Femoral Artery Bifurcation, it is crucial not to occlude the Superficial Femoral Artery (SFA) during the procedure.
However, due to the small diameter of the Deep Femoral Artery (2.8mm), stent graft placement was ruled out as an option. Stent graft insertion typically requires a minimum diameter of 6mm or more, and even if the diameter were around 6mm, it’s a frequently folded location, which increases the risk of stent graft damage.
Therefore, the decision was made to proceed with embolization by using coils or a vascular plug to completely exclude the Deep Femoral Artery, as this method is more feasible in preventing further bleeding.
The A-line was inserted near the Left Superficial Femoral Artery (SFA), so there weren’t significant difficulties with the puncture. Although there appeared to be a reduced diameter due to volume loss, it was not a significant challenge for inserting a 5Fr sheath.
This is an angiography procedure performed using a 5Fr 75cm Davis catheter through the Left Common Femoral Artery (CFA). While the Femoral artery bifurcation is visible, there is some overlap in the AP view, making it challenging to locate the bleeding point.
This is an angiography procedure conducted at an LAO 40-degree angle. No bleeding is visible. Since the bleeding was located just below the bifurcation, it appears to have spontaneously ceased. Unfortunately, but fortunately for the patient, we concluded the procedure as it is.

Q-radiology

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