Letter to the Editor: Percutaneous closure of an iatrogenic common femoral arteriovenous fistula secondary to extracorporeal membrane oxygenation access: a case report

We report a case of successful percutaneous common femoral arteriovenous fistula (AVF) closure using a Perclose ProGlide closure device (Abbott Vascular).A 56-year-old man who was receiving treatment for acute myocardial infarction decannulated the venoarterial extracorporeal membrane oxygenation (VA-ECMO) cannula inserted into the right common femoral artery (CFA) and common femoral vein (CFV) percutaneously (Fig. 1A) [1].Although VA-ECMO decannulation and hemostasis were successful, post-decannulation angiography revealed a common femoral AVF (Fig. 1B,C).The fistula had a short and wide neck.In most cases, if AVF is not leading to high-output cardiac failure in a critically ill patient, then common practice is close observation and follow-up and/or open repair.However, due to concern of potential deleterious hemodynamic effects of highoutput cardiac failure after discontinuation of ECMO in a patient who has recently suffered an acute myocardial infarction, we elected to perform urgent closure of AVF.We accessed the AVF directly with a 21-G needle (Merit Advance angiography needle; Merit Medical) with the overlay image of the angiogram.A 0.014-inch guidewire