Critical lower limb ischemia with lumbricals paralysis from an embolized Angio-Seal closure device

Femoral artery access site complications following angiographic procedures range from 1% to 5 %. Arterial percutaneous closure devices (APCD) could lead to severe vascular complications, like acute lower limb ischemia. Despite vascular injuries being uncommon after APCD deployment, generally a complex surgical repair is necessary.

We report a case of lower limb acute ischemia following Angio-Seal closure device deployment by skilled endovascular interventionalists.

We present a case of acute CLI secondary to angioseal embolization with endovascular repair. Hemostasis was achieved using the Angioseal closure device. Within 12 hours of procedure patient started having right toe numbness with foot drop.

Within few hours, patient started to have right foot pain with ABI of 0.13 on right side and no flow visualized in proximal SFA. Patient was taken to the cath lab for acute on chronic right limb ischemia. There was no flow in distal CFA.

The absorbable collagen plug in our patient was not absorbed and had caused acute obstruction flow to distal CFA. We hypothesized that the lack of distal blood flow hardened and the plug and further propagated lack of absorption. The plug was easily displaced by a single NC balloon inflation. We did PVI to complete occlusion of common femoral artery; post PVI with <10% residual stenosis per op note with + doppler at DP. ABI in right lower extremity is 0.13 prior to vascularization now 0.5. CK trended down from 1374 to 1051. Patient recovered neurological function.

The Angioseal embolization is a rare complication and should be suspected early. Endovascular treatment is a safe alternative to surgical cutdown.