while the intimal lesions, frequently limited on the posterior wall, play a minor role.In our opinion, a transverse arteriotomy at the level of the Angio-Seal introduction site could lead to a safe removal of the anchorage system, permitting a sufficient exploration of the posterior intimal layer. We retain that this has been the surgical approach on patient 3 in this report. Moreover, in the case of a posterior intimal defect, a limited resection of the flap and a Kunlin suture can be performed easily. This approach is preferable, in our opinion, allowing the avoidance of a longitudinal arteriotomy and usage of a prosthetic patch for the arterial reconstruction. In our experience, the longitudinal arteriotomy can be reserved only where there is an extensive intimal lesion, previously demonstrated by a transverse arteriotomy or in cases of diffuse atherosclerotic involvement of the common femoral artery.Moreover, if longitudinal arteriotomy is the only option, we suggest the use of an autologous saphenous vein patch to decrease the possibility of infection as demonstrated by Gonzo et al. [3][4][5] In conclusion, we believe the ischemic complication of the Angio-Seal device should be approached by a transverse arteriotomy, without the use of prosthetic material. An eventual autologous vein patch is the preferred material when an arterial reconstruction is needed.