Resuscitative endovascular balloon occlusion of the femoral artery (REBO-F) and stenting from the brachial access after left main percutaneous coronary intervention

The growing number of percutaneous cardiac interventions is increasing together with incidence of iatrogenic vascular complications is increasing. Percutaneous endovascular techniques have expanded, becoming an appealing alternative to surgery. When rupture is detected, bleeding control treatment is usually performed from the ipsilateral or contralateral femoral. In this study, we presented a case of a left common femoral artery rupture treated percutaneously from brachial access. A 74-year-old very obese female patient was admitted to our center for non-ST elevation acute coronary syndrome. Coronary angiography, performed from the left groin due to the lack of alternative access sites, showed left main critical ostial disease treated with PCI and stenting. Despite closure device use at the end of the procedure, hemodynamically unstable left groin hematoma was formed. Angiography of the left iliac-femoral axis performed from right brachial access showed access vessel rupture. Balloon tamponade was performed to control bleeding followed by implantation of a covered stent. Vascular perforation or rupture is a serious complication. Morbidly obese patients may further complicate interventional circumstances making manual compression non efficacious. Patients presenting with complex vascular disease is becoming more frequent. Knowledge and practice of different access sites may help dealing with such difficult scenarios.