Transpedal intervention for common femoral artery stenosis caused by a suture-mediated vascular closure device after transcatheter aortic valve replacement

Suture-mediated vascular closure devices (VCDs) can rarely cause common femoral artery (CFA) stenosis or occlusion after transfemoral transcatheter aortic valve replacement (TAVR). Optimal endovascular strategies remain unclear, particularly when the lesion involves posterior-wall dissection. A 74-year-old woman underwent transfemoral TAVR via the right CFA with a suture-mediated VCD using a pre-close technique. Immediately after the procedure, distal perfusion was preserved; however, she developed right lower-limb claudication the next day. Duplex ultrasonography and computed tomography angiography revealed severe right CFA stenosis with posterior-wall dissection. Because an antegrade or contralateral transfemoral approach was considered to increase the risk of inadvertent guidewire passage into the false lumen, we selected a retrograde transpedal intervention (TPI) via the right dorsalis pedis artery. The lesion was successfully crossed in the true lumen and treated with plain old balloon angioplasty, resulting in complete resolution of the pressure gradient without the need for stenting. Follow-up ultrasonography showed no restenosis, and the patient remained asymptomatic for 5 years. TPI may be a useful and safe alternative for VCD-related CFA stenosis with dissection after TAVR, facilitating true-lumen crossing while avoiding additional femoral access.