Abstract

Peripheral artery disease (PAD) is a common vascular condition, particularly among diabetic patients. Treatment options include exercise and pharmacological therapy, while interventional strategies such as percutaneous procedures and surgical approaches are also employed. In cases where complications arise during percutaneous interventions, conversion to surgery may be considered. This report presents a complication encountered during peripheral angioplasty that was successfully managed without surgical intervention. A 48-year-old male patient presented with leg pain during walking and persistent coldness in the right foot. Peripheral angiography revealed plaques in the left iliac and common femoral arteries, with 90% stenosis in the mid-segment of the left superficial femoral artery. Distal arteries were patent. On the right side, the iliac artery was plaque-laden, and the mid-segment of the superficial femoral artery was totally occluded (100%), with patent distal runoff. Balloon angioplasty was planned for both sides, starting with the left. A long sheath was placed in the left iliac artery via crossover from the right femoral artery. The lesion was crossed with a Halbert wire, followed by predilatation using a 5.0×40 mm balloon and deployment of a 6.0×60 mm self-expandable stent. During withdrawal of the stent balloon, the distal tip of the long sheath fractured and migrated distally within the superficial femoral artery. The fragment was stabilized using a 2.0×20 mm balloon and retrieved along with the sheath. It was observed to have migrated subcutaneously, and a small skin incision allowed for successful removal. This case illustrates a rare complication during PAD intervention—sheath tip fracture—and its effective management. Prompt recognition and careful technique enabled resolution without surgical conversion, emphasizing the importance of preparedness in interventional procedures.