title: Nitinol clip distal migration and resultant popliteo-tibial artery occlusion complicating access closure by the StarClose SE vascular closure system.
abstract: Lower extremity ischemia following deployment of a vascular closure device for access site closure after a transfemoral endovascular procedure rarely occurs. A 68-year-old woman diagnosed with subarachnoid hemorrhage due to a ruptured anterior communicating aneurysm was treated by endovascular coil embolization. The StarClose SE device was deployed for right femoral arteriotomy closure. After 2 days, critical ischemia occurred on her right lower leg due to total occlusion of the popliteo-tibial artery. Emergent surgical embolectomy was performed and the nitinol clip of the StarClose device was captured in the lumen of the tibioperoneal trunk. Although StarClose is an extravascular closure system, intravascular deployment, distal migration, and resultant critical limb ischemia can occur.
authors.affiliation: Department of Neurosurgery, College of Medicine, Gachon University, Incheon, Republic of Korea.
authors.forename: Dae Han
authors.initials: DH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, College of Medicine, Gachon University, Incheon, Republic of Korea.
authors.forename: Myeong Jin
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, College of Medicine, Gachon University, Incheon, Republic of Korea.
authors.forename: Chan Jong
authors.initials: CJ
authors.lastname: Yoo
authors.affiliation: Department of Neurosurgery, College of Medicine, Gachon University, Incheon, Republic of Korea.
authors.forename: Cheol Wan
authors.initials: CW
authors.lastname: Park
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000601:surgery; D017128:Embolectomy; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D007866:Leg / Q000098:blood supply; D011150:Popliteal Artery / Q000601:surgery; D013345:Subarachnoid Hemorrhage / Q000628:therapy; D013525:Surgical Instruments / Q000009:adverse effects*; D016909:Tibial Arteries / Q000601:surgery; D016896:Treatment Outcome
keywords: Aneurysm; Artery; Coil; Complication; Device