Fogarty Catheter Removal of External Iliac Artery Thrombus Caused by Sheath-Related Thrombus Entrapment Following Mechanical Thrombectomy: A Case Report.

Objective: The transfemoral approach is commonly used in neuroendovascular procedures. However, access-site complications, although infrequent, can have serious clinical consequences. Acute limb ischemia (ALI) is a particularly serious condition, carrying a significant risk of limb loss and death and therefore requires rapid diagnosis and urgent management. Case Presentation: We report a rare case of acute external iliac artery occlusion due to a thromboembolism at the distal end of a femoral sheath after mechanical thrombectomy for acute ischemic stroke. During the procedure, reflux from both the guiding catheter and the femoral sheath disappeared, raising suspicion of an access-site complication; a contralateral femoral access angiography was performed. This evaluation revealed complete occlusion of the external iliac artery. Immediate thrombectomy was performed via a cut-down approach using a Fogarty arterial embolectomy catheter (Edwards Lifesciences, Irvine, CA, USA), resulting in the rapid restoration of arterial blood flow. The patient experienced neither limb ischemia nor neurological deterioration and achieved a favorable outcome. Conclusion: Thrombotic occlusion at the tip of a femoral sheath is a rare but potentially devastating complication of neuroendovascular procedures. The loss of reflux from a femoral sheath should alert clinicians to the possibility of access-vessel thrombosis and prompt immediate vascular evaluation and multidisciplinary intervention.