Puncture Site Balloon Dilation for Sheath Insertion Difficulties in Percutaneous Endovascular Aneurysm Repair with Previous Femoral Cutdown

<b>Purpose:</b> This study aimed to show balloon dilation of the puncture site as a technique to facilitate insertion of a large-bore sheath in patients undergoing percutaneous endovascular aneurysm repair who have previously undergone femoral cutdowns. <b>Materials and Methods:</b> Three patients with prior femoral cutdowns who required percutaneous insertion of a large-bore sheath were included. After ultrasound-guided puncture of the femoral artery and preparation with a Perclose ProGlide suture, attempts to insert a 12F sheath using a dilator were unsuccessful. Consequently, a 5-mm-diameter balloon catheter was used to dilate the puncture site. <b>Results:</b> In two patients, the balloon dilation allowed smooth sheath insertion without bleeding complications. Adequate hemostasis was achieved post-procedure. However, in the third patient, despite high-pressure balloon dilation, residual stenosis prevented sheath insertion. The stenosis was attributed to the puncture path crossing vascular sutures from the previous cutdown, leading to a decision to relocate the puncture site, which then allowed successful sheath insertion. <b>Conclusion:</b> Balloon dilation at the puncture site is a viable technique for overcoming challenges in sheath insertion during percutaneous endovascular aneurysm repair in patients with previous femoral cutdowns. In cases in which the puncture site cannot be dilated with the use of a balloon, alternative strategies, such as changing the puncture site, are necessary.