Endovascular Management of Superficial Femoral Artery Occlusion Secondary to Embolization of Celt ACD(®) Vascular Closure Device

Patient: Male, 70-year-old Final Diagnosis: Embolization of vascular closure device Symptoms: Claudication Medication: — Clinical Procedure: Angioplasty Specialty: Radiology OBJECTIVE: Unusual clinical course BACKGROUND: This report describes the endovascular management of a Celt ACD(®) vascular closure device (VCD) lodged in the superficial femoral artery (SFA), 1 year after its deployment. There is a paucity of evidence in the existing literature regarding the management of complications related to embolized VCD discovered months or years after its deployment. CASE REPORT: A 70-year-old male patient, who was a heavy smoker, presented with right lower-limb intermittent claudication of 2 months’ duration. He underwent a successful left retrograde iliac artery and left SFA angioplasty 1 year ago. The right femoral pulse was normal, whereas the right popliteal pulse was absent. The right ankle-brachial index was 0.64. Doppler ultrasound showed evidence of mid-right SFA occlusion. Angiogram showed an embolized Celt ACD VCD in the right SFA causing segmental occlusion. An endovascular attempt to retrieve the embolized VCD via a snare failed, as the VCD got deeply embedded in the vessel wall. After successful balloon angioplasty, a stent was placed into the SFA with excellent angiographic and clinical outcomes. CONCLUSIONS: This case demonstrates the risk of dislodgement of the VCD and its distal embolization with a risk of late ischemia. Endovascular retrieval may be unsuccessful for chronically embolized VCD. Therefore, stent angioplasty is an acceptable option.