Endovascular management of iatrogenic femoral access site vascular injuries: A case series and literature review

<h2>Abstract</h2><h3>Objective</h3> Iatrogenic major vascular injuries at femoral artery access sites are potentially life-threatening complications of endovascular procedures. Although open surgical repair remains the standard treatment, it carries significant morbidity. Endovascular management using covered stent grafts, deployed via a contralateral or ipsilateral approach, presents a minimally invasive alternative in selected cases. This study reports a single-center experience with an endovascular-first strategy and review of relevant published data. <h3>Methods</h3> A retrospective single-center observational study was conducted between 2016 and 2024. Patients treated with covered stent grafts for iatrogenic vascular access site injuries, defined as access site-related hemorrhage or pseudoaneurysm involving the external iliac artery, common femoral artery or superficial femoral artery, were included. The most common mechanism of injury requiring stenting was closure device failure. A literature review of published data on PubMed was performed. The primary outcomes assessed were technical success and stent graft patency during follow-up. <h3>Results</h3> A total of 20 access site-related vascular injuries were treated using covered stent grafts. Technical success was achieved in 95% (19/20). Stent graft patency was maintained in 100% of cases at 30 days (n = 15) and 1 year (n = 11). The literature review identified 15 studies and a total of 585 patients treated with covered stent grafts with technical success in nearly 100% and preserved stent graft patency throughout a follow-up period ranging from 3 months to a maximum of 3 years in all but a handful of cases. <h3>Conclusions</h3> Endovascular repair using covered stent grafts is a viable treatment option for iatrogenic access site vascular injuries of the external iliac, common femoral, and superficial femoral arteries. This approach may be particularly beneficial for frail patients or those with hemodynamic instability. Further studies are needed to confirm long-term outcomes and optimal patient selection.