S. Sreeram et al., RETROPERITONEAL HEMATOMA FOLLOWING FEMORAL ARTERIAL CATHETERIZATION -A SERIOUS AND OFTEN FATAL COMPLICATION, The American surgeon, 59(2), 1993, pp. 94-98
Retroperitoneal hematoma (RPH) following cardiac catheterization is an
infrequent (0.15% incidence) but morbid complication. During a 13-mon
th study period, 11 patients with a significant RPH requiring operativ
e intervention were identified. The mean transfusion requirement was 8
.7 units, with two deaths as a consequence of their RPH. Adjunctive ca
rdiac procedures included percutaneous transluminal coronary angioplas
ty (five), stent placement (one), and thrombolysis (two). Two patients
had RPH following aortography. Suspicion of RPH was most frequently p
rompted by a falling hematocrit (73%), with hypovolemic shock (cystoli
c blood pressure < 90) in 64%. Lower quadrant or flank pain occurred i
n four patients. Lower extremity pain occurred in five patients due to
femoral nerve compression. Of six patients with a preoperative femora
l nerve palsy, complete resolution occurred in four cases. RPH followi
ng femoral arterial puncture is a cause of significant morbidity, part
icularly in the anticoagulated patient. Postcatheterization anticoagul
ation and high arterial puncture were the principal risk factors (p <
0.001). Early recognition is essential and should be prompted by a fal
ling hematocrit, lower abdominal pain, or neurological changes in the
lower extremity. There should be a low threshold for performing abdomi
nopelvic CT scans in such patients. Management of RPH must be individu
alized: 1) patients with neurological deficits in the ipsilateral extr
emity require urgent decompression of the hematoma, 2) anticoagulation
should be stopped or minimized, 3) hematoma progression by serial CT
necessitates surgical evacuation and repair of the arterial puncture s
ite.