Vascular Complication of Transfemoral PCI: A Case of Pulmonary Embolism Due to Femoral Pseudoaneurysm-Induced Deep Vein Thrombosis

Percutaneous coronary intervention (PCI) is essential to achieve reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Thrombolytic therapy prior to PCI reduces morbidity and mortality, but increases the risks of vascular complications, particularly with transfemoral access. Here, we report a rare vascular complication—a pulmonary embolism (PE)—caused by thrombus embolization from a femoral artery pseudoaneurysm following transfemoral PCI. A 74-year-old woman with sudden dyspnea and desaturation shortly after being discharged post-PCI for inferior STEMI. Clinical examination revealed extensive right femoral ecchymosis, anemia, and elevated levels of D-dimer and cardiac troponin. Computed tomography pulmonary angiography demonstrated a saddle PE extending into segmental pulmonary arteries, and imaging identified a femoral artery pseudoaneurysm causing significant venous compression and deep vein thrombosis. Initial anticoagulation therapy resulted in hematuria and an expanding hematoma, necessitating suspension and placement of an inferior vena cava filter. This case underscores the importance of recognizing and managing rare but potentially severe vascular complications following transfemoral PCI, emphasizing individualized risk assessment and treatment strategies.