Percutaneous closure using a Perclose ProGlide device for an iatrogenic femoral arteriovenous fistula caused by venoarterial extracorporeal membrane oxygenation insertion: A case report

Background: Iatrogenic femoral arteriovenous fistula (AVF) is a representative complication of a percutaneous femoral approach to cannulation. Because open surgical repair is highly invasive, endovascular treatment for AVFs is receiving increasing attention. We report a case of successful percutaneous AVF closure using a Perclose ProGlide closure device. Case presentation: A 56-year-old man underwent percutaneous venoarterial extracorporeal membrane oxygenation decannulation and hemostasis. Final angiography showed an AVF, with a short and wide neck. We directly punctured the fistula with fluoroscopic guidance using a 21-G puncture needle. A 0.014-inch wire was inserted and replaced with a 0.035-inch wire, and the arteriovenous fistula was occluded using the Perclose ProGlide device. We performed additional balloon dilation to occlude blood flow to the AVF from the femoral artery and vein. The shunt flow almost completely disappeared, and complete disappearance of the AVF was confirmed by vascular ultrasound 6 months later. Conclusions: This interventional technique using a Perclose ProGlide devicemay offer a treatment option for iatrogenic AVFs, particularly those with a short and wide neck or those involving the common femoral artery, where conventional techniques may not be suitable