Percutaneous treatment of post catheterization massive retroperitoneal hemorrhage

Mak, Gary; Daly, Barry; Chan, Wilson; Tse, Kin; Chung, HY; Woo, Kam-Sang

doi:10.1002/ccd.1810290109

Cited by 17 publications

(10 citation statements)

References 8 publications

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“…Mak et al [16] described controlling retroperitoneal bleeding by tamponading the puncture site with a peripheral angioplasty balloon. The bleeding site is localized by performing an angiogram from the contralateral femoral arterial access and gaining control of the bleeding by tamponade with a peripheral angioplasty balloon or deployment of a covered stent (Fig.…”

Section: Retroperitoneal Hemorrhagementioning

confidence: 99%

Percutaneous management of access site complications

Samal

White

2002

Cathet Cardio Intervent

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Percutaneous cardiac catheterization and endovascular procedures are associated with complications at the vascular access site. While surgery has been the traditional treatment for vascular access complications, the current state of the art permits percutaneous management of many access site complications. Surgical repair may be required only when percutaneous methods fail, are not available, or are unsuitable.

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Section: Retroperitoneal Hemorrhagementioning

confidence: 99%

Percutaneous management of access site complications

Samal

White

2002

Cathet Cardio Intervent

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“…However, its systematic use to attain hemostasis in patients with retroperitoneal bleeding has not been described. Only two case reports have been published in the literature, of which one was performed intraoperatively [13,14] and the other percutaneously [5]. Previous reports have also described the use of microcoils [14], or chemical procoagulant substances such as polyvinyl alcohol, gelfoam, [15,16], and, more recently, natural procoagulants such as thrombin [17], to induce arterial thrombosis after coronary guidewire perforation unsuccessfully sealed with prolonged balloon inflation.…”

Section: Discussionmentioning

confidence: 91%

“…In addition to identifying the site of blood loss, this procedure is used to obtain hemostasis with balloon catheter inflation as a temporary measure while awaiting surgical repair [1] or even as a definitive treatment, as has been reported previously [5].…”

Section: Introductionmentioning

confidence: 98%

Endovascular treatment of a massive retroperitoneal bleeding: Successful balloon-catheter delivery of intra-arterial thrombin

Silva

Stant

Ramee

2005

Cathet. Cardiovasc. Intervent.

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Retroperitoneal bleeding is a potentially lethal complication of percutaneous intervention, when the common femoral artery is used as vascular access. Surgery, the traditional treatment for this complication in patients with persistent bleeding or hemodynamic instability, carries a considerable risk of morbidity and mortality. We report a case of life-threatening retroperitoneal bleeding successfully treated percutaneously with balloon occlusion and catheter delivery of thrombin to attain thrombosis of a lacerated branch of the common femoral artery. Endovascular catheter-based percutaneous treatment for massive retroperitoneal bleeding is often effective and should be pursued in selected patients.

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“…7 A number of therapeutic measures have been advocated: reduction or discontinuation of anticoagulants, supportive transfusion 8 and balloon tamponade of the actively bleeding femoral artery. 9 As described in our experience, consideration should be given to the placement of a covered stent to seal the site of RPH identified at selective DSA.…”

Section: Discussionmentioning

confidence: 96%

Answer

Geoghegan¹,

Khosa²,

Persaud³

et al. 2005

CJEM

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T he answer is B. Contrast-enhanced computed tomography (CT) was performed. It demonstrated a large right-sided retroperitoneal hematoma displacing the bladder to the left side of the pelvis. The hematoma extended from the level of the junction of the right external iliac artery to the ipsilateral common femoral artery. A catheter sheath was present in the left common femoral artery, which remained in situ following completion of the angioplasty. A selective femoral digital subtraction angiogram (DSA) was subsequently performed on the right side. The DSA demonstrated the presence of a small tear at the junction of the right external iliac artery and the ipsilateral common femoral artery (Fig. 1). The defect appeared small in calibre, measuring 1-2 mm in diameter. No other significant findings were evident in the aorta or common iliac vessels.After discussion with the referring team, it was decided to place a covered stent over the area of the tear of the right common femoral artery. The stent was deployed using a 6-mm balloon. A follow-up DSA performed immediately after the placement of the stent demonstrated resolution of the retroperitoneal leak and restoration of hemodynamic stability (Fig. 2). A repeat CT performed 48 hours after the procedure demonstrated a significant decrease in the size of the retroperitoneal hematoma, with the stent in situ at the junction of the right external iliac and ipsilateral common femoral arteries. The patient made an uneventful recovery and remained well at follow-up. DiscussionArterial cannulation may cause vascular disruption. As the number of diagnostic and therapeutic cardiac and radiological interventional procedures increases, the complications associated with arterial puncture occur with increasing frequency. Complications include bleeding, false aneurysm formation, infection, arterial occlusion from thrombosis or dissection and arteriovenous fistula formation. Characteristically, complications occur more often in therapeutic procedures than in diagnostic investigations. Documented risk factors for these complications include advanced age; female gender; obesity; atheroma at the puncture site; aortic regurgitation; hypertension and the use of aspirin, warfarin

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Percutaneous treatment of post catheterization massive retroperitoneal hemorrhage

Abstract: We describe a patient on anticoagulant therapy with massive retroperitoneal and intraperitoneal bleeding complicating femoral catheterization. Balloon tamponade of the actively bleeding femoral artery was effective in sealing off the leakage after failed surgical exploration.

Cited by 17 publications

References 8 publications

Percutaneous management of access site complications

Percutaneous management of access site complications

Endovascular treatment of a massive retroperitoneal bleeding: Successful balloon-catheter delivery of intra-arterial thrombin

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