Under local anesthesia and mild sedation, angioplasty (Mustang balloon dilation catheters 8 × 40 mm, 9 × 30 mm and 10 × 30 mm, Boston Scientific, United States) of the right CFA and external iliac arteries (EIAs) was performed with crossover technique from the contralateral groin, with guidewire placed distally in the superficial femoral artery (SFA). At control angiography, contrast medium extravasation from the right EIA was seen, and two covered stents (Advanta 8 × 38 mm, Rastatt, Germany) were placed (Fig. 7.2).

Right arterial access was then obtained by puncture of CFA under fluoroscopic guidance. After preparation of the vessel with a 9-F vascular sheath, a 10-F ProStar XL closure device (Abbott Vascular Devices, Redwood City, California) was inserted, and sutures were deployed, needles removed, and sutures secured using the pre-closure technique. A 16-F delivery sheath (Edwards eSheath) was then inserted over a stiff wire placed in the left ventricle. After valve predilation with a 23 mm balloon, the Edwards Sapien 3 26 mm valve prosthesis was successfully implanted with rapid ventricular pacing. The vascular access sheath was then removed, and the pre-laid sutures of the Prostar device were tied in place. The result was checked by angiography via the crossover sheath, with evidence of another contrast medium extravasation at the vessel entry site (Fig. 7.3). Thus, double covered stenting under fluoroscopic guidance was performed using the guidewire previously positioned into the distal SFA. Final control angiography showed no residual contrast medium extravasation. Prior to discharge, angio-CT scan showed stents’ patency with complete sealing of vessel rupture (Fig. 7.4).