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Case report
Republished: Nitinol clip distal migration and resultant popliteo-tibial artery occlusion complicating access closure by the StarClose SE vascular closure system
  1. Dae Han Choi,
  2. Myeong Jin Kim,
  3. Chan Jong Yoo,
  4. Cheol Wan Park
  1. Department of Neurosurgery, College of Medicine, Gachon University, Incheon, Republic of Korea
  1. Correspondence to Dr M J Kim, Department of Neurosurgery, College of Medicine, Gachon University, 783, Namdong road, Namdong-gu, Incheon 405-835, Republic of Korea; skymedi{at}


Lower extremity ischemia following deployment of a vascular closure device for access site closure after a transfemoral endovascular procedure rarely occurs. A 68-year-old woman diagnosed with subarachnoid hemorrhage due to a ruptured anterior communicating aneurysm was treated by endovascular coil embolization. The StarClose SE device was deployed for right femoral arteriotomy closure. After 2 days, critical ischemia occurred on her right lower leg due to total occlusion of the popliteo-tibial artery. Emergent surgical embolectomy was performed and the nitinol clip of the StarClose device was captured in the lumen of the tibioperoneal trunk. Although StarClose is an extravascular closure system, intravascular deployment, distal migration, and resultant critical limb ischemia can occur.

  • Aneurysm
  • Complication
  • Coil
  • Device
  • Artery

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  • Republished with permission from BMJ Case Reports Published 30 March 2016; doi:10.1136/bcr-2015-012257

  • Contributors Management of the case: MJK. Literature search: DHC, CJY, and CWP. Writing the article: DHC. Revision of the article: DHC, MJK, CJY, and CWP. Overall responsibility: DHC and MJK.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.