Retroperitoneal Haemorrhage from Femoral Access

  • Stavros Spiliopoulos
  • Konstantinos Katsanos
  • Dimitris Karnabatidis
  • Dimitrios Tsetis
  • Dimitris Siablis
Chapter

Abstract

One of the most fearful major complications related with common femoral artery access is retroperitoneal haemorrhage, occurring in less than <1 % of the patients undergoing peripheral endovascular procedures and more frequently following coronary interventions. Groin-expanding haematomas are macroscopically evident, but a massive retroperitoneal haematoma can rapidly develop without external signs of bleeding, despite manual compression. This occult bleeding into the pelvis, which usually occurs after high femoral puncture above the inguinal ligament (delineated by the origin of the inferior epigastric artery), should be clinically suspected whenever hypotension, tachycardia, loss of ipsilateral distal pulses, faintness, confusion, lower quadrant abdominal pain and/or any other signs of hypovolemic shock are present immediately after groin haemostasis or even several hours later.

Keywords

Lactate Heparin Prothrombin Protamine 

References

  1. 1.
    Matsi PJ, Manninen HI. Complications of lower-limb percutaneous transluminal angioplasty: a prospective analysis of 410 procedures on 295 consecutive patients. Cardiovasc Intervent Radiol. 1998;21(5):361–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Spiliopoulos S, Katsanos K, Karnabatidis D, Diamantopoulos A, Christeas N, Siablis D. Safety and efficacy of the StarClose vascular closure device in more than 1000 consecutive peripheral angioplasty procedures. J Endovasc Ther. 2011;18:435–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Lumsden AB, Miller JM, Kosinski AS, et al. A prospective evaluation of surgically treated groin complications following ­percutaneous cardiac procedures. Am Surg. 1994;60(2):132–7.PubMedGoogle Scholar
  4. 4.
    Tsetis D. Endovascular treatment of complications of femoral arterial access. Cardiovasc Intervent Radiol. 2010;33:457–68.PubMedCrossRefGoogle Scholar
  5. 5.
    Mak GY, Daly B, Chan W, et al. Percutaneous treatment of post catheterization massive retroperitoneal hemorrhage. Cathet Cardiovasc Diagn. 1993;29:40–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Al Wahbi A. Stent-grafts in the management of life-threatening hemorrhage following inadvertent femoral catheterization in high-risk patients: report of two cases and review of the literature. Vasc Health Risk Manag. 2010;6:1111–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Tana PL, Gibson M. Central venous catheters: the role of radiology. Clin Radiol. 2006;61:13–22.CrossRefGoogle Scholar
  8. 8.
    Dabney A, Bastani B. Enoxaparin-associated severe retroperitoneal bleeding and abdominal compartment syndrome: a report of two cases. Intensive Care Med. 2001;27:1954–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Stavros Spiliopoulos
    • 1
  • Konstantinos Katsanos
    • 1
  • Dimitris Karnabatidis
    • 1
  • Dimitrios Tsetis
    • 2
    • 3
  • Dimitris Siablis
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyPatras University Hospital, School of MedicineRioGreece
  2. 2.Department of Angiography and Interventional Radiology, University Hospital of Heraklion, Faculty of MedicineUniversity of CreteHeraklionGreece
  3. 3.Department of Radiology, Interventional Radiology UnitHeraklion University Hospital, School of Medicine CreteHeraklionGreece

Personalised recommendations