Iatrogenic perforation of the medial circumflex artery following femoral venous cannulation for transcatheter aortic valve replacement, presenting with retroperitoneal hematoma and successfully managed by percutaneous embolization and coiling.

Vascular complications are a major concern during transcatheter aortic valve replacement and can occur independently of introducer size. Arterial and venous access must be meticulous to avoid potentially life-threatening bleeding, which most commonly results from injury to the common femoral or iliac arteries. We report an unusual case of perforation of the medial circumflex branch of the common femoral artery resulting from attempted femoral venous cannulation. Injury to this vessel is characteristically associated with silent retroperitoneal extravasation and is notoriously difficult to recognize and treat. Despite identification of the perforation on contrast-enhanced computed tomography, the anatomical site could only be localized to the medial circumflex branch on highly selective contrast angiography. Thereafter, it was successfully treated percutaneously by embolization and coiling.