RETROPERITONEAL HEMATOMA FOLLOWING FEMORAL ARTERIAL CATHETERIZATION -A SERIOUS AND OFTEN FATAL COMPLICATION

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.