J Cerebrovasc Endovasc Neurosurg.  2024 Jun;26(2):223-226. 10.7461/jcen.2024.E2023.06.002.

Percutaneous femoral access: Stuck guide wire, decannulation difficulty due to unravelling and knotting

• Chauhan BPS
• Dholakia B
• Khan A
• Hirani C
• Kumar S
• Mahakul DJ
• Katyal A
• Nazir W
• Singh D

• KMID: 2556986
• DOI: http://doi.org/10.7461/jcen.2024.E2023.06.002

Abstract

Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid and minimally invasive approach than open procedures. Common complications associated with this peripheral puncture include hematoma, bleeding, pseudoaneurysm, arteriovenous fistula, retroperitoneal bleeding, inadvertent venous puncture, dissection, etc. The retrograde femoral access is currently the most frequently used arterial access as it is technically straightforward, allows for the use of larger size sheaths and catheters, allows repeated attempts, etc. Although being technically less challenging, grave complications can occur due to hardware failure. Here, we present a case of unruptured posterior inferior cerebellar artery (PICA) aneurysm, who underwent uneventful diagnostic cerebral digital substraction angiography (DSA) via right femoral artery route on first attempt, but on second attempt for therapeutic intervention, landed up with stuck guide wire and faced decannulation difficulty due to unravelling of guide wire and multiple knot formation, which was finally removed after multiple attempts at pulling and improvised manoeuvres. Such cannulation and decannulation difficulties have been reported multiple times for central venous access, but extremely rarely for femoral routes, making this case a rarity and worth reporting.

Keyword

Percutaneous; Fermoral; Access; Deccanulation; Stuck; Guide wire

Figure

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  Fig. 1. Cerebral DSA selective shoot of right vertebral artery showing right proximal PICA aneurysm. DSA, digital substraction angiography; PICA, posterior inferior cerebellar artery

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  Fig. 2. (A) Fluoroscopic image showing check flow with guide wire, and its inferiorly directed loop in the femoral artery. (B) Fluoroscopic image showing multiple loops and knotting of guide wire in the common femoral artery. (C) Fluoroscopic image showing MPC (catheter) negotiated upto the first bend, couldn’t be negotiated any further, and failed to straighten the wire. (D) Image showing distal end has separated into rigid central core (arrow head) and overlying soft part (arrow), which has unravelled (box magnified view). Multiple loops formed by the unravelled soft part seen in the proximal end after removal. MPC, multipurpose catheter

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