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.
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