A 85-year-old man with a severe aortic valve stenosis underwent transcatheter aortic valve implantation (TAVI). Based on dimensions measured by cardiac computed tomography, the heart team decided to perform a transfemoral TAVI using a 29 mm Sapien3 system. The patient had heavily calcified iliac and femoral arteries and an abdominal aortic aneurysm (Figure 1A). After gaining vascular access, a Perclose ProGlideä (Abbott) percutaneous closure device (PCD) was readily inserted into the femoral artery but fractured during pullback at the joint between the ridged proximal metal shaft and the flexible distal half. The distal portion remained in the vessel resulting in major bleeding from the puncture site (Figure 1B). Capture and retrieval of the remaining device via a second sheath in the superficial femoral artery was unsuccessful and device’s location remained unchanged (Figure 1C). We continued the TAVI procedure via the left femoral artery and completed implantation of the transcatheter heart valve. Another attempt to snare the fractured PCD from the contralateral side failed. While capturing the soft tip was easily accomplished, the fragment stretched when pulling without any noticeable movement of main device. In order to decrease friction along the aortic bifurcation and to minimize risk of tearing, we covered the distal PCD tip with a 12F cross-over sheath. After snaring the PCD, the 12F was advanced over the aortic bifurcation into the proximal right iliac artery, retrieving it cross-over by surmounting the bending point (iliac artery bifurcation) and using the cross-over sheath as sheath. The trapped fragment was successfully retracted through removal of the entire sheath (Figure 2A). The patient showed no major bleeding or vascular complications, remained in conscious-sedation during the whole procedure and recovered quickly.
To our knowledge, this is the first report of a successful catheter-based retrieval of a fractured PCD from an arterial transfemoral access.

Our case highlights the importance of minimizing friction when retrieving material from tortuous vessels, or as in this case, via a retrograde access over the aortic bifurcation (Figure 2B - C). This technique may save patients from open surgical removal and limit potential further complications.

Figure 1

Figure 2