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Bleeding complications of femoral catheterization: CT evaluation
S O Trerotola1, J E Kuhlman, E K Fishman
1Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21205.
Insights
Computed tomographic (CT) scans help identify and manage significant hematomas after cardiac and vascular procedures. This imaging is crucial for guiding treatment, monitoring patients, and predicting the need for interventions like surgery.
Area of Science:
- Radiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Post-catheterization hematomas are a known complication.
- Accurate diagnosis and characterization are essential for appropriate management.
Purpose of the Study:
- To evaluate the role of computed tomographic (CT) scans in diagnosing and managing significant post-catheterization hematomas.
- To identify the types and locations of hematomas identified by CT.
Main Methods:
- Retrospective review of CT scans and clinical data from 21 patients with post-catheterization hematomas.
- Categorization of hematoma types (retroperitoneal, intraperitoneal, groin/thigh, abdominal wall).
- Analysis of clinical data including medications, transfusion needs, and outcomes.
Main Results:
- CT identified four distinct types of hematomas.
- CT findings guided treatment decisions in all patients, influencing monitoring and surgical prediction.
- 17 patients required blood transfusions (average 5 units), and 2 needed surgery for vessel repair.
Conclusions:
- CT is a valuable tool for diagnosing and characterizing post-catheterization hematomas.
- CT imaging aids in clinical decision-making, including the need for intensive monitoring and potential surgical intervention.
- Significant hematomas often necessitate blood transfusions and, in some cases, surgical repair.
Abstract:
Computed tomographic (CT) scans and clinical data were reviewed in 21 patients with significant hematoma occurring after catheterization. The procedures included percutaneous transluminal coronary angioplasty (n = 15), cardiac catheterization (n = 2), peripheral angioplasty (n = 2), valvuloplasty (n = 1), and venous access catheterization (n = 1). Clinical data including medications, transfusion requirements, and sequelae were obtained by reviewing the patients' charts. Four distinct types of postcatheterization bleeding were identified at CT: retroperitoneal, intraperitoneal, groin and thigh, and abdominal wall hematomas. CT scans contributed to treatment in all patients by helping indicate the need for more intensive monitoring and by helping predict the potential need for surgery. Sequelae included the need for blood transfusions in 17 patients (mean of 5 units of blood in each patient receiving transfusion) and surgery in two patients for vessel repair.