Native Superficial Femoral Artery Peripheral Atherectomy Site Pseudoaneurysm: A Case Report

Objectives: We report a case of pseudoaneurysm formation in a native superficial femoral artery (SFA) after percutaneous atherectomy using SilverHawk^TM atherectomy device. Peripheral atherectomy site pseudoaneurysms have been rarely reported in the literature and those reported have been limited to peripheral vein grafts. As yet, there are no reported cases of atherectomy site pseudoaneurysm formation in a treated arterial segment.
Methods: A 46 year old female patient was referred to us for blue toe syndrome affecting the left great toe. Angiogram revealed a focal lesion in the left SFA. This stenosis was then treated with percutaneous atherectomy. She developed ectasia of the SFA at the atherectomy site that progressed to a pseudoaneurysm of 2.8 cm diameter in an 8 cm segment of treated SFA over a 3 month period.
Results: The atherectomy site pseudoaneurysm was successfully treated by placing a covered stent in the superficial femoral artery. She returned at 2 months with an in-stent stenosis of the SFA, which was treated with a balloon angioplasty.
Conclusions: There is a renewed interest in the technique of percutaneous atherectomy with the availability of the SilverHawk^TM device, which has a different design than the previous generation devices. This technique has a definite risk of vessel wall trauma leading to pseudoaneurysm formation. The endovascular surgeon must recognize this risk, arrange appropriate follow up imaging and plan bail-out procedures if required.