Retroperitoneal Bleeding after Cardiac Catheterization: A 7-Year Descriptive Single-Center Experience

Abstract

Background: Retroperitoneal bleeding (RPB) is an unusual but potentially fatal vascular complication occurring after cardiac catheterization (CC). Contemporary data of RPB in the era of dual antiplatelet therapy and vascular closure devices are lacking. Methods: We retrospectively examined all RPB cases that occurred after CC in the Rabin Medical Center between the years 2005 and 2011. Results: Of 26,487 patients who underwent CC, a total of 48 patients (mean age 60.9 ± 13.8 years, 52.1% female) with RPB were identified (0.18%). The indication for CC was acute coronary syndrome (43.7%), myocardial infarction (35.4%), stable angina pectoris (8.3%), hemodynamic studies for valvular heart disease (10.4%) and others (2.1%). Coronary intervention was performed in 34 patients (70.9%) and a vascular closure device (VCD) was used in 16 patients (33.3%). Seventy-seven percent of patients were treated with clopidogrel, 20.8% with glycoprotein IIb-IIIa inhibitors and 85.4% with anticoagulation during CC. Median time to diagnosis of bleeding was 9.0 h, while the median time to bleeding differed between patients with and without a VCD (12 vs. 5 h, respectively). The clinical presentation of RPB was hemorrhagic shock in 39.6% of patients and 50.0% required at least one blood transfusion. Patients were managed either with conservative treatment (79.2%), angiography stenting (14.6%) or vascular surgery (6.2%). A total of 3 patients died during hospitalization, of which RPB was the etiology in 2 (4.2%). Conclusions: RPB which is a rare complication of CC is associated with younger age and female gender, ascompared to patients without RPB. Onset of bleeding can be delayed in patients with VCDs. With careful and early diagnosis, most patients with RPB after CC can be managed conservatively.

Vascular puncture site complications - diagnosis, therapy, and prognosis

“…Especially, bleeds to the iliopsoas muscle result clinically in painful leg movement, palsy and other neuropathic sensations in the eff ector region of the femoral nerve [22,23]. Blood transfusions are necessary in up to 50 % of respective patients [11,13,24]. Sonographic evaluation is the fi rst diagnostic step along with clinical judgment, but is often inconclusive, resulting in the need for diff erent modalities like computed tomography [24] with or without contrast media (Figures 2 and 3).…”

“…Blood transfusions are necessary in up to 50 % of respective patients [11,13,24]. Sonographic evaluation is the fi rst diagnostic step along with clinical judgment, but is often inconclusive, resulting in the need for diff erent modalities like computed tomography [24] with or without contrast media (Figures 2 and 3). Angiography may also be necessary.…”

“…Finally, only 20 % require invasive treatment by either again interventional percutaneous procedures or direct vascular surgery [24]. The surgical approach could be diffi cult due to the anatomical accessibility.…”

Bleeding Complications in Percutaneous Coronary Interventions

“…In this issue of Cardiology, Eisen et al [2] study the problem of retroperitoneal bleeding in a cohort of patients undergoing diagnostic or therapeutic angiography in a single center between 2005 and 2011 (n = 26,487 patients). The risk of retroperitoneal bleeding was small (0.18%) but associated with significant mortality.…”

Retroperitoneal Hemorrhage after Cardiac Catheterization and Percutaneous Coronary Interventions

“…In the latest issue of Cardiology, Eisen et al [12] report their experience from a single center in Israel in 26,487 patients who had undergone femoral artery catheterization. They report that only 48 patients (0.18%) had a retroperitoneal bleed following femoral artery catheterization.…”