Neurovascular Cases

  • Complications of transfemoral artery catheterization include pseudoaneurysm development, creation of an arteriovenous fistula, arterial dissection, distal embolization and nerve damage.
  • Hemorrhage into the superficial tissues → noticeable groin hematoma. However, hemorrhage from the common femoral artery may track into the retroperitoneal space, which can accommodate a large volume of blood.
  • Occult bleeding into the retroperitoneal space may be recognized in a delayed fashion. Because there is no cutaneous bleeding and no visible or palpable groin hematoma, the most common scenario is that patients are found to have new onset tachycardia (due to hypovolemia) and ↓ hemoglobin and hematocrit counts.
  • If a retroperitoneal hematoma is suspected, then CT scan of the abdomen and pelvis is used to identify fluid tracking through the retroperitoneal space and CT angiography can identify any active bleeding point, if one exists.

In this case the patient's femoral artery injection demonstrates an anatomically unremarkable puncture site at the mid-point of the bony femoral head and above the bifurcation of the common femoral artery.

Nevertheless, the patient was found to be tachycardic with a significantly decreased hemoglobin and hematocrit several hours after the endovascular procedure was finished.

CT angiogram of the abdomen and pelvis shows significant stranding and organized hematoma in the retroperitoneal spaces within the pelvis. There is no obvious acute arterial extravasation.