Cor Vasa 2025, 67(Suppl.3):89-92 | DOI: 10.33678/cor.2025.078
Late-onset acute limb ischemia after transcatheter patent foramen ovale closure with Occlutech Figulla Flex II PFO Occluder
- a Department of Cardiology, University Hospital, Bratislava, Slovakia
- b Department of Cardiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
- c Department of Diagnostic and Interventional Radiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
- d Department of Cardiosurgery, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
Background: Thrombus formation is an exceedingly rare complication after transcatheter patent foramen ovale (PFO) occlusion. To the best of the authors' knowledge, a case of late symptomatic thrombosis of Occlutech Figulla Flex II PFO occluder has not yet been published. Case presentation: A 45-year-old man with a history of peripheral artery embolism, and subsequent PFO closure with Occlutech Figulla Flex II PFO occluder. The patient completed dual antiplatelet therapy with clopidogrel (75 mg/day) and aspirin (100 mg/day) after 6 months and subsequently continued single antiplatelet therapy (SAPT) with clopidogrel for other eight months. Five months after the discontinuation of SAPT (i.e. 19 months after PFO closure), he was readmitted with a clinical and ultrasound presentation of acute limb ischemia of the left lower extremity. Transtoracic and transesophageal echocardiography revealed a huge left atrial mass, attached to the left atrial disc of the occluder. The residual shunt was not present. A catheter embolectomy from the left femoral artery was performed. Computed tomography after two months of warfarin anticoagulation showed identical findings to echocardiography. Activated protein C resistance was found. The mass was surgically extirpated and the atrial septal defect was corrected with a pericardial patch. Pathology confirmed the mass to be a thrombus.
Conclusion: Thromboembolism after PFO closure with an Occlutech Figulla Flex II PFO occluder is an excep- tional complication that can occur late after the procedure despite antithrombotic prophylaxis.
Keywords: Acute limb ischemia, Occlutech Figulla Flex II PFO occluder, Patent foramen ovale, Percutaneous closure, Thrombus
Received: March 2, 2025; Revised: March 2, 2025; Accepted: July 6, 2025; Prepublished online: June 2, 2012; Published: September 1, 2025 Show citation
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