Answer

Abstract

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