Popliteal Artery Pseudoaneurysm following FoxHollow Atherectomy: A Rare Complication

ABSTRACT: Atherectomy using the FoxHollow device is an exciting treatment as an alternative to lower extremity arterial bypass for treatment of peripheral vascular disease in symptomatic patients with critical limb ischemia and disabling claudication. We present an interesting case of popliteal artery pseudoaneurysm following FoxHollow atherectomy, which is a rare complication. Mechanical factors have been implicated in causation of trauma to the vessel wall during atherectomy. Endovascular treatment of peripheral vascular disease has become increasingly common, thus it is important to know the rare complications associated with it. Pseudoaneurysm is one of the rare complications associated with the use of the FoxHollow atherectomy device.

J INVASIVE CARDIOL 2008;20:477–478


Atherectomy using the FoxHollow device (FoxHollow Technologies, Redwood City, California) is an exciting treatment alternative to lower-extremity arterial bypass for the treatment of peripheral vascular disease in symptomatic patients with critical limb ischemia and disabling claudication. Peripheral atherectomy is often appealing, as it is associated with lower periprocedural morbidity and mortality rates. Common early complications related to this device include the need for emergency access-site surgery, retroperitoneal hemorrhage, vascular perforation or plaque dissection.1  Pseudoaneurysm formation at the atherectomy site in the native artery is one of the rare complications associated with the FoxHollow device. We report the case of a patient who developed a large pseudoaneurysm in the segment of the popliteal artery treated with atherectomy.

Case Report. An 80-year old female with a significant past medical history of peripheral vascular disease, hypertension, diabetes mellitus, coronary artery disease and hyperlipidemia presented to a local hospital with an ulcer on her left foot and osteomyelitis. She was transferred to our hospital for critical limb ischemia of the left foot and underwent peripheral angiography. She had undergone a peripheral angiogram 2 years prior in the same hospital for a nonhealing left foot ulcer. She was found to have peripheral vascular disease with a > 80% stenosis of the left popliteal artery which was treated with a FoxHollow atherectomy device (Figure 1). According to the patient’s history, the ulcer healed to some extent, but worsened 6 months prior to this admission. Angiography at this admission showed a left popliteal artery pseudoaneurysm along with a 60–70% stenosis of the left tibioperoneal trunk (Figure 2). Our plan is to monitor the patient clinically and consider repeat angiography or computed tomographic scan to measure the size of the pseudoaneurysm by quantitative analysis within the next 6 months to a year.

Discussion. The FoxHollow atherectomy device is a relatively new monorail atherectomy catheter designed for more efficient and easier plaque removal.2 Its use has increased recently because in contrast to classic coronary directional atherectomy, the FoxHollow allows for single-operator procedures. The use of this device obviated the need for adjunctive balloon angioplasty and stenting.3 The development of a pseudoaneurysm in a coronary artery following atherectomy has been reported as a rare occurrence and can occur in any peripheral artery treated by atherectomy. Mechanical factors have been implicated in the causation of trauma to the vessel wall during atherectomy. These include the tortuous nature of the vessel, an oversized atherectomy device, lesions close to a prior surgical scar and the location of a lesion near side branches. Endovascular treatment of peripheral vascular disease has become increasingly common, thus it is important to be aware of even the rare complications associated with this procedure. Pseudoaneurysm is one of the rare complications associated with FoxHollow device use.