Retroperitoneal hematoma after cardiac catheterization: prevalence, risk factors, and optimal management

Retroperitoneal hematoma is an unusual, but potentially serious, complication after cardiac catheterization. The predisposing factors, typical presentation, and clinical course of this iatrogenic complication are identified, and the role of surgery in its treatment is defined.

A retrospective review of 9585 femoral artery catheterizations over a 5-year period allowed identification and evaluation of all patients with retroperitoneal hemorrhage.

Retroperitoneal hematoma developed in 45 patients (overall prevalence 0.5%), with the highest frequency after coronary artery stenting (3%). In the group of patients who underwent coronary artery stenting, statistically significant predictors of this complication included protocol for sheath removal, female sex, nadir platelet count, and excessive anticoagulation. Signs and symptoms included suprainguinal tenderness and fullness in 100%, severe back and lower quadrant pain in 64%, and femoral neuropathy in 36%. Most patients were treated successfully with transfusion alone. Seven patients (16%) required operation; in four, hypotension unresponsive to volume resuscitation developed early after catheterization; and, in three, a progressive fall in hematocrit level led to surgery 24 to 72 hours after catheterization.

Retroperitoneal hematoma after cardiac catheterization can usually be treated by transfusion alone. A small subset of patients who have development of hypotension unresponsive to volume resuscitation require urgent operation.