Abdominal Wall Hematoma as a Rare Complication following Percutaneous Coronary Intervention

Abstract

Abdominal wall hematoma is a rare but potentially serious vascular complication that may develop after coronary angiographic procedures. In particular, an oblique muscle hematoma caused by an injury of the circumflex iliac artery is very rare, yet can be managed by conservative treatment including hydration and transfusion. However, when active bleeding continues, angiographic embolization or surgery might be needed. In this study, we report an uncommon case of injury to the circumflex iliac artery by an inappropriate introduction of the hydrophilic guidewire during the performance of a percutaneous coronary intervention.

Best practices for vascular arterial access and closure: a contemporary guide for the cardiac catheterization laboratory

“…Despite these potential advantages, randomized data supporting this strategy is lacking, and it is advised that institutions develop best practices around vessel puncture, regardless of which needle platform is used ( 88 ). Once TFA is obtained, a 0.018″ micro access guidewire should then be advanced under fluoroscopy to ensure appropriate passage, avoiding the circumflex iliac artery, as inadvertent perforation of this vessel with a guidewire may lead to an abdominal hematoma, requiring blood transfusion and endovascular intervention ( 89 ). A 4 Fr microcatheter dilator should then be advanced over the guidewire.…”

“…Once TFA is obtained, a 0.018″ micro access guidewire should then be advanced under fluoroscopy to ensure appropriate passage, avoiding the circumflex iliac artery, as inadvertent perforation of this vessel with a guidewire may lead to an abdominal hematoma, requiring blood transfusion and endovascular intervention ( 89 ).…”