How to Stop the Puncture Site Bleeding at

How to Stop the Puncture Site Bleeding at High. Bifurcated Common Femoral Artery? Sang Yeub Lee, MD, Ph. D Chungbuk National University Hospital

Sang Yeub Lee, MD, Ph. D I have no relevant financial relationships

F/68 • 10 DA chest pain • Underlying disease – HTN – Hypothyroidism – NSTEMI (2018) s/p PCI at LM-p. LAD, LM-p. LCx, d. LCx

EKG Normal sinus rhythm

Chest-X ray

F/68 Diagnosis : unstable angina FU CAG

Previous femoral puncture angiography 2018 High bifurcation

Previous CAG and post PCI image 2018 LM-LAD 4. 0 X 28 mm LCx os 3. 0 X 18 mm d. LCx DES 3. 0 X 23 mm

FU Coronary angiography 2019

Lt main bifurcatin lesion : crossover to femoral access 2018 angiogram High bifurcation

Sono guided puncture

Micropuncture system under sono guidance

Puncture at just above high bifurcation area

Post PCI image : LM intervention with Kissing, POT

Hemostasis with closing device (femoseal)

Hemostasis with compression device • Manual compression with compression device • Post procedure 1 hour later • Dizziness • Nausea • bradycardia • Pale face and extremity • hypotension

Peripheral angiography via Lt femoral access

Extravasation at puncture site

Another sheath at Lt femoral artery with 8 F sheath SEAL graft stent 8 x 60 mm (S&G Bio. Tech, South Korea)

Balloon dilatation with 6 X 50 mm

Angiogram after graft stent implantation

Post Rt. CFA graft stent implantation • Hemoglobin 13. 5 -> 10. 1 • No further complication of both femoral puncture site

Conclusion & Discussion point • Large-bore sheaths for structural heart procedures and advanced MCS devices have been used more frequently. • Emerging approaches to arteriotomy, and new-generation VCD have a role in reducing vascular complications and bleeding • Very High CFA puncture is associated with retroperitoneal bleeding that makes fatal complication. • Graft stent implantation is one of good treatment option to stop the fatal iliac bleeding.

Thank you for your attention.