Risk factors for the development of retroperitoneal hematoma after percutaneous coronary intervention in the era of glycoprotein IIb/IIIa inhibitors and vascular closure devices

Abstract

Female gender, low BSA, and higher femoral artery puncture are significant risk factors for RPH. Awareness of the determinants and clinical features of RPH may aid in prevention, early recognition, and prompt treatment.

Retroperitoneal Hematoma After Femoral Arterial Catheterization

“…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). These hematomas are often mistaken for adnexal masses in female patients and should be on the differential of any women presenting with a poorly defined adnexal mass after recent femoral artery catheterization (7).…”

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 .…”

“…[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 . RPH is associated with high inhospital mortality (6.64% vs. 1.07%) in those without RPH, due in part to the often insidious presentation.…”

“…RPH is associated with high inhospital mortality (6.64% vs. 1.07%) in those without RPH, due in part to the often insidious presentation. 7 The majority of patients (84-92.3%) with RPH are treat medically, with few requiring surgery 5,7 , though placement of a covered stent is an acceptable treatment with favorable anatomy. In one review the average drop in hemoglobin among patients with RPH was 11.5 +5¸compared with 2.3+ 3.3 in controls.…”

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

“…[2] Retroperitoneal hemorrhage is an uncommon but potentially fatal complication of TFA PCI occurring in approximately 0.5-0.74% of transfemoral procedures. [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.…”