Femoral vein occlusion after VASCADE MVP resolved without surgery: a case report.

Background: VASCADE MVP® is a vascular closure device developed to achieve haemostasis of large-bore venous access by deploying a collagen patch in the subcutaneous tissue. While its efficacy and safety have been demonstrated, venous occlusion has not been previously reported. Case summary: A 72-year-old woman was hospitalized and underwent pulmonary vein isolation for symptomatic paroxysmal atrial fibrillation. Two femoral venous sheaths (10-Fr and 8.5-Fr) were inserted under ultrasound guidance, and haemostasis was achieved using VASCADE MVP Venous Vascular Closure devices. On postoperative day 9, right leg swelling appeared. Contrast-enhanced CT showed stenosis of the right common femoral vein (CFV), and duplex ultrasound revealed a hyperechoic structure distal to the stenosis. Since deep vein thrombosis was suspected, the apixaban dose was adjusted from 10 to 20 mg/day. Due to persistent symptoms, venography was performed on Day 15, which revealed complete CFV occlusion. Intravascular endoscopy revealed white intraluminal material consistent with residual collagen, and subsequent balloon angioplasty led to partial restoration of blood flow. Given the gradual improvement in symptoms, conservative management was pursued, leading to complete recovery at 2 months as confirmed by duplex ultrasound. Discussion: This is the first reported case of venous occlusion likely caused by residual collagen from a collagen-based venous closure device. Balloon angioplasty restored partial blood flow, and surgical intervention was avoided due to the identification of collagen-induced reversible mechanical obstruction. When using VASCADE MVP, operators should be mindful to avoid intravascular deployment of collagen by ensuring proper technique.