Brachial artery approach for managing retroperitoneal bleed following coronary intervention for STEMI

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Primary percutaneous coronary intervention (PPCI) is the standard treatment for ST-elevation myocardial infarction (STEMI).
• Femoral arterial access is often preferred for PPCI, especially in hemodynamically unstable patients.
• Complications, though rare, can include femoral artery perforation and life-threatening retroperitoneal hemorrhage.

Observation:

• A male patient in his 50s presented with cardiac arrest due to inferolateral STEMI.
• PPCI was successfully performed using ultrasound-guided right femoral artery access.
• The patient subsequently deteriorated, diagnosed with a retroperitoneal hematoma from femoral artery perforation.

Findings:

• A covered stent was successfully deployed in the right femoral artery via left brachial artery access, achieving hemostasis.
• The patient recovered and was discharged two weeks post-procedure.
• Percutaneous treatment of femoral artery perforation complications is a viable alternative to open surgical repair.

Implications:

• Early recognition and management of retroperitoneal hemorrhage are crucial.
• Percutaneous techniques offer a minimally invasive option for managing life-threatening complications of femoral arterial access during PPCI.
• This case highlights the importance of considering endovascular solutions for iatrogenic vascular injuries.