A case of pseudoaneurysm after endovascular therapy with atherectomy and paclitaxel-coated balloon for superficial femoral artery lesion

An 83-year-old woman with claudication in the right lower extremity was referred to our hospital. Since angiography showed severe stenosis with a severely calcified lesion extending from the ostial to proximal part of the right superficial femoral artery (SFA), endovascular therapy (EVT) with the Jetstream™ atherectomy system (Boston Scientific, Marlborough, MA, USA) and paclitaxel-coated balloon (PCB) was performed. Atherectomy was performed using the Jetstream™ atherectomy catheter SC 1.85, followed by an additional atherectomy using the Jetstream™ atherectomy catheter XC 2.1/3.0. Subsequently, angiography and intravascular ultrasound (IVUS) images showed the enlargement of lumen area due to the reduction of calcified plaque, but even some of the healthy media on the side free of calcified plaque had been removed. Next, a PCB dilation was performed, and the final angiography showed adequate dilation. However, the symptoms recurred 9 months after EVT. Angiography revealed an enlarged vessel suggestive of pseudoaneurysm at the ostial part of the right SFA and severe stenosis distal to the enlarged vessel. IVUS images showed a pseudoaneurysm and severe stenosis due to calcified nodules distal to the pseudoaneurysm. This case suggests that pseudoaneurysm is a potential complication of EVT with the Jetstream™ atherectomy system and PCB for SFA lesions.

Learning objective: The Jetstream™ atherectomy system (Boston Scientific, Marlborough, MA, USA) has developed to improve outcomes for femoropopliteal artery lesions with severely calcified lesions in lower extremity arterial disease by removing calcified plaque and improving vascular compliance. Several clinical reports demonstrated durable patency rates and low complication rates after endovascular therapy using the atherectomy device. However, pseudoaneurysm is a potential complication of endovascular therapy with the Jetstream™ atherectomy system.