Perforation of the Brachial Artery During Percutaneous Lower Extremity Angioplasty via the Brachial Artery Approach Resulting in Difficulties in Balloon Catheter Removal: A Case Report.

Percutaneous endovascular treatment of peripheral vascular disease with small-caliber short sheaths may lead to device removal difficulties. A 50-year-old woman on hemodialysis underwent endovascular intervention for right common femoral artery stenosis, via the right brachial artery. A 4-Fr short sheath was used for the procedure owing to a previous hematoma at the puncture site. However, the balloon catheter could not cross the calcified lesion and was difficult to remove. A microcatheter was inserted and withdrawn, but the guidewire was kinked and could not be retrieved. Surgical retrieval of the guidewire and balloon catheter was performed. The kinked guidewire and microcatheter had migrated outside the vessel. In peripheral vascular intervention, the use of a long sheath in the brachial artery approach is important. Forcible removal of a difficult-to-remove catheter may cause further vascular damage. Therefore, it is essential to stop immediately and consider surgical treatment.