Retroperitoneal Hematoma After Percutaneous Coronary Intervention: Prevalence, Risk Factors, Management, Outcomes, and Predictors of Mortality

Abstract

Retroperitoneal hematoma is an uncommon complication of contemporary percutaneous coronary intervention associated with high morbidity and mortality. The identification of risk factors for the development of RPH could lead to modification of procedure strategies aimed toward reducing its incidence.

Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage

“…Observed mortality rate in patients with TFA-related retroperitoneal hemorrhage has been previously reported to be 8.6%. [6,7,10] Medical litigation related to in hospital mortality after TFA was significantly higher in our study, constituting 58.8% of all claims. This finding can be partially attributed to a higher tendency for family member to pursue legal advice and file a legal claim against the physician and the hospital after a Continued... rare yet recognized procedure-related event.…”

“…[3][4] Female gender, low body surface area, chronic renal failure, use of glycoprotein IIb/IIIa inhibitors, presentation with acute myocardial infarction (MI), and high placement of the sheath (above the inferior epigastric artery) have been reported as the most significant risk factors for retroperitoneal hemorrhage in various studies. [5,6] Mortality rates following retroperitoneal hemorrhage remain high, 8.6% in those experiencing a bleeding episode versus 2.4% in contemporary clinical practice, which has led to the modification of procedure strategies aiming to reduce its incidence. [6,7,10] Transradial approach (TRA) for cardiac catheterization has consistently demonstrated significant reduction in bleeding and vascular complications as shown in multiple clinical trials [8][9][10] and has led to increasing adoption of TRA worldwide.…”

“…[5,6] Mortality rates following retroperitoneal hemorrhage remain high, 8.6% in those experiencing a bleeding episode versus 2.4% in contemporary clinical practice, which has led to the modification of procedure strategies aiming to reduce its incidence. [6,7,10] Transradial approach (TRA) for cardiac catheterization has consistently demonstrated significant reduction in bleeding and vascular complications as shown in multiple clinical trials [8][9][10] and has led to increasing adoption of TRA worldwide. In the United States, the adoption of TRA has lagged overall and now is estimated at 30% of all diagnostic and PCI procedures performed.…”

Retroperitoneal Hematoma After Femoral Arterial Catheterization

“…Placement of a coronary artery stent has been associated with the highest risk of hematoma development, whereas placement of a diagnostic catheterization or coronary atherectomy has been associated with the lowest risk (2). Risk factors for this complication include female gender, low body surface area, higher femoral puncture site, use of vasculature closure devices, chronic renal insufficiency, chronic obstructive pulmonary disease, and use of preprocedural anticoagulation (3)(4)(5). Although initially asymptomatic, the hematoma, once large enough, can cause cutaneous bruising, lower abdominal pain, back and flank pain, and lead to shock (6).…”

Inferior STEMI Complicated by Retroperitoneal Hemorrhage due to Ruptured AAA

“…Retroperitoneal hemorrhage (RPH) is a feared complication of cardiac catheterization via femoral access, with prevalence ranging from 0.4% to 0.74%. [5][6][7] Features include groin pain in 42-100%, back pain in 23-64%, and hypotension in 92%. Female gender, low body surface area, and high arterial puncture are recognized risk factors; one review found no association between RPH and sheath size, GpIIb/IIIa inhibition, and use of a closure device 5 , though others have shown a link between sheath size and use of closure device 7 .…”