[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-414041-105":59,"doc-detail-414041-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","salvage-of-undeflatable-intra-stent-angioplasty-balloon-catheter-with-direct-percutaneous-needle-puncture","Salvage of undeflatable intra-stent angioplasty-balloon-catheter with direct percutaneous needle puncture","","Balloon angioplasty and stenting are routine endovascular treatments for peripheral arterial disease, but rare balloon deflation failures can be dangerous. A 65-year-old man with diabetes, dyslipidaemia, long smoking history, and chronic limb-threatening ischemia presented with recurrent ulceration. Angiography revealed chronic total occlusion of a previously stented superficial femoral artery. After stent post-dilation, the balloon failed to deflate despite repeated standard attempts and flushing, and could not be withdrawn without risking injury. A fluoroscopy-guided 21-gauge direct percutaneous puncture through the stent struts enabled complete aspiration collapse, and final angiography showed restored patency without arterial damage.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/salvage-of-undeflatable-intra-stent-angioplasty-balloon-catheter-with-direct-percutaneous-needle-puncture/414041/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/salvage-of-undeflatable-intra-stent-angioplasty-balloon-catheter-with-direct-percutaneous-needle-puncture/414041.png","ImageObject",300,407,{"name":92,"@type":93},"Olivia Brown","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why was balloon deflation failure considered dangerous in this peripheral intervention?","Question",{"text":113,"@type":114},"The fully expanded balloon obstructed blood flow and could not be safely withdrawn without risking stent deformation or vascular injury.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What technique successfully managed the undeflatable balloon in the case?",{"text":118,"@type":114},"A fluoroscopy-guided 21-gauge microset puncture needle directly punctured the balloon through the stent struts, followed by aspiration to achieve complete deflation.",{"name":120,"@type":111,"acceptedAnswer":121},"What was the outcome after the direct puncture bailout?",{"text":122,"@type":114},"Aspiration collapsed the balloon, the catheter was removed intact, reinflation confirmed the puncture site without further defects, and final angiography showed no arterial injury or recoil with restored SFA patency.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},414041,1790716659,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":39,"preview_page_count":4},16904993612988,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Pasquetti et al. CVIR Endovascular (2025) 8:119 [https://doi.org/10.1186/s42155-025-00638-8](https://doi.org/10.1186/s42155-025-00638-8)  \nCVIR Endovascular  \n LETTER TO THE EDITOR Open Access  \nSalvage of undeflatable intra-stent angioplasty-balloon-catheter with direct percutaneous needle puncture  \nLeonardo Pasquetti1* , Edoardo Pasqui 1, Giuseppe Galzerano1, Elisa Lazzeri 1, Bruno Gargiulo1 and Gianmarco de Donato 1  \nKeywords Undeflatable balloon, Direct puncture, Stent, CTO, SFA  \nMain text Background  \nUSA) and then relined with two 6 × 170 mm Pulsar-18 T3 stents (Biotronik SE&Co. KG, Berlin, Germany). Post-  \nTo the Editor,  \nBalloon angioplasty and stenting are standard components of endovascular treatment for peripheral arterial disease. Although balloon inflation and deflation are routine steps, failure of a balloon to deflate is an exceptionally rare but potentially dangerous complication [1]. Evidence from coronary interventions exists, but applicability to peripheral vessels is limited due to differences in vessel calibre, calcium burden, and device design [2]. Here, we describe a case of balloon deflation failure inside a stented superficial femoral artery (SFA), successfully managed with a direct percutaneous puncture.  \nCase presentation  \nA 65-year-old man with diabetes, dyslipidaemia, heavy smoking history, and chronic limb-threating ischemia (Rutherford V) presented with recurrent ulceration of the left forefoot stump. Angiography showed chronic total occlusion (CTO) of a previously stented SFA. The lesion was crossed and prepared with plain-old balloons (Advance Serenity 5 × 150 mm and 6 × 150 mm, Cook Medical, Bloomington, IN, USA) and a non-compliant balloon (Dorado 7 × 150 mm, BD, Franklin Lakes, NJ,  \n*Correspondence: Leonardo Pasquetti  \n[l.pasquetti@student.unisi.it](l.pasquetti@student.unisi.it); [leonardo.pasquetti1@gmail.com](leonardo.pasquetti1@gmail.com)  \n1 Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci, Siena, Italy  \ndilation was performed with the previously used 6-mm hydrophilic-coated over-the-wire balloon. At the end of inflation, the balloon failed to deflate despite repeated attempts with standard measures, including repeated flushing and inflation above the rated burst pressure. The fully expanded balloon obstructed blood flow and could not be withdrawn without risking stent deformation or vascular injury (Fig. 1A). A percutaneous bailout technique was adopted. Under fluoroscopic guidance in a single-plane projection, a 21-gauge, 7-cm microset puncture needle with a transitionless-tip design was advanced through the mid-thigh skin and vessel wall to directly puncture the balloon through the stent struts (Fig. 1B). Subsequently, back “bleeding” (the mix of saline and contrast medium) was observed (Fig. 1C). Passive deflation was insufficient, so aspiration with a 10-cc syringe enabled complete balloon collapse. The catheter was removed intact. Reinflation outside the body confirmed the puncture site without other structural defects (Fig. 2). Final angiography demonstrated no arterial injury or recoil, with restored SFA patency.  \nDiscussion  \nEntrapment or inability to deflate a balloon is exceedingly uncommon, especially in peripheral interventions. In the coronary field, multiple bailout techniques have been described: intentional rupture via overinflation, high tip-load guidewire puncture, cutting the hypotube to restore luminal continuity [3], guide extension-mediated  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’","cbCainkwqNyet6AP","https://ap.wps.com/l/cbCainkwqNyet6AP","pdf",889914,"English","# Case presentation\n## Patient presentation and diagnosis\n## Failed balloon deflation and percutaneous bailout\n# Discussion\n## Rarity in peripheral interventions and proposed mechanism\n## Clinical implications and prevention","[{\"question\":\"Why was balloon deflation failure considered dangerous in this peripheral intervention?\",\"answer\":\"The fully expanded balloon obstructed blood flow and could not be safely withdrawn without risking stent deformation or vascular injury.\"},{\"question\":\"What technique successfully managed the undeflatable balloon in the case?\",\"answer\":\"A fluoroscopy-guided 21-gauge microset puncture needle directly punctured the balloon through the stent struts, followed by aspiration to achieve complete deflation.\"},{\"question\":\"What was the outcome after the direct puncture bailout?\",\"answer\":\"Aspiration collapsed the balloon, the catheter was removed intact, reinflation confirmed the puncture site without further defects, and final angiography showed no arterial injury or recoil with restored SFA patency.\"}]","Salvage of undeflatable intra-stent angioplasty-balloon-catheter with direct percutaneous needle puncture | PDF",1790596450]