Usefulness of Transpedal Intervention for Inferior Epigastric Artery Bleeding Following Catheter Ablation: A Case Report

Abstract

Background Cardiovascular interventions may result in access site complication, including inferior epigastric artery (IEA) bleeding. IEA injury are generally treated through surgery and transcatheter embolisation; however, additional complications should be avoided in the bailout procedure. Here, we present a case of catheter ablation complicated by IEA haemorrhage that we managed by transcatheter embolisation using a trans-pedal intervention (TPI). Case summary A 58-year-old man underwent catheter ablation for symptomatic paroxysmal atrial fibrillation (PAF). Pulmonary vein isolation was performed uneventfully via catheterisation of the right femoral artery and vein access. After the procedure, he complained of persistent abdominal pain and had a palpable mass in the lower right abdomen. Computed tomography angiography (CTA) revealed a haematoma in the right rectus abdominis with signs of active bleeding from a branch of the right inferior epigastric artery (IEA). We performed transcatheter arterial embolisation through a transpedal intervention (TPI) to stop bleeding and avoid further complication. No leakage of contrast media was detected after embolisation using a micro coil and the abdominal pain improved. We did not observe any serious intraprocedural complications. Discussion Catheter ablation procedures may be complicated by access site complications such as active bleeding. Arterial embolisation is a feasible treatment approach to control the resulting haemorrhage. Embolisation through the transpedal route (transpedal intervention) could be an effective bailout technique in the setting of emergent transcatheter arterial embolisation to achieve haemostasis and avoid further complication.