Abstract
Percutaneous coronary intervention (PCI) is essential to achieve reperfusion in patients
with ST-segment elevation myocardial infarction (STEMI). Thrombolytic therapy prior
to PCI reduces morbidity and mortality, but increases the risks of vascular complications,
particularly with transfemoral access. Here, we report a rare vascular complication—a
pulmonary embolism (PE)—caused by thrombus embolization from a femoral artery pseudoaneurysm
following transfemoral PCI. A 74-year-old woman with sudden dyspnea and desaturation
shortly after being discharged post-PCI for inferior STEMI. Clinical examination revealed
extensive right femoral ecchymosis, anemia, and elevated levels of D-dimer and cardiac
troponin. Computed tomography pulmonary angiography demonstrated a saddle PE extending
into segmental pulmonary arteries, and imaging identified a femoral artery pseudoaneurysm
causing significant venous compression and deep vein thrombosis. Initial anticoagulation
therapy resulted in hematuria and an expanding hematoma, necessitating suspension
and placement of an inferior vena cava filter. This case underscores the importance
of recognizing and managing rare but potentially severe vascular complications following
transfemoral PCI, emphasizing individualized risk assessment and treatment strategies.
Keywords
pulmonary embolism - percutaneous coronary intervention - femoral artery pseudoaneurysm
- transfemoral PCI - STEMI - vascular complication - deep vein thrombosis
