Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Retroperitoneal Hematoma as a Serious Complication of Endovascular Aneurysmal Coiling

  • Murai, Yasuo (Department of Neurosurgery, Nippon Medical School) ;
  • Adachi, Koji (Department of Neurosurgery, Nippon Medical School) ;
  • Yoshida, Yoichi (Department of Neurosurgery, Nippon Medical School) ;
  • Takei, Mao (Department of Neurosurgery, Nippon Medical School) ;
  • Teramoto, Akira (Department of Neurosurgery, Nippon Medical School)
  • Received : 2009.12.03
  • Accepted : 2010.06.14
  • Published : 2010.07.28
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Abstract

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be lifethreatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.

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References

  1. Akata T, Nakayama T, Kandabashi T, Kodama K, Takahashi S : Massive retroperitoneal hemorrhage associated with femoral vein cannulation. J Clin Anesth 10 : 321-326, 1998 https://doi.org/10.1016/S0952-8180(98)00036-1
  2. Bejjani GK, Bank WO, Olan WJ, Sekhar LN : The efficacy and safety of angioplasty for cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 42 : 979-986; discussion 986-987 1998 https://doi.org/10.1097/00006123-199805000-00013
  3. Haviv YS, Nahir M, Pikarski A, Shiloni E, Safadi R : A late retroperitoneal hematoma mimicking acute appendicitis--an unusual complication of coronary angioplasty. Eur J Med Res 1 : 591-592, 1996
  4. Illescas FF, Baker ME, McCann R, Cohan RH, Silverman PM, Dunnick NR : CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography. AJR Am J Roentgenol 146 : 1289-1292, 1986 https://doi.org/10.2214/ajr.146.6.1289
  5. Kalinowski EA, Trerotola SO : Postcatheterization retroperitoneal hematoma due to spontaneous lumbar arterial hemorrhage. Cardiovasc Intervent Radiol 21 : 337-339, 1998 https://doi.org/10.1007/s002709900272
  6. Kent KC, Moscucci M, Mansour KA, DiMattia S, Gallagher S, Kuntz R, et al. : Retroperitoneal hematoma after cardiac catheterization : prevalence, risk factors, and optimal management. J Vasc Surg 20 : 905-910; discussion 910-913, 1994 https://doi.org/10.1016/0741-5214(94)90227-5
  7. Lin PH, Dodson TF, Bush RL, Weiss VJ, Conklin BS, Chen C, et al. : Surgical intervention for complications caused by femoral artery catheterization in pediatric patients. J Vasc Surg 34 : 1071-1078, 2001 https://doi.org/10.1067/mva.2001.119043
  8. Lodge JP, Hall R : Retroperitoneal haemorrhage : a dangerous complication of common femoral arterial puncture. Eur J Vasc Surg 7 : 355-357, 1993 https://doi.org/10.1016/S0950-821X(05)80025-8
  9. Lubavin BV : Retroperitoneal hematoma as a complication of coronary angiography and stenting. Am J Emerg Med 22 : 236-238, 2004 https://doi.org/10.1016/j.ajem.2004.02.025
  10. Mak GY, Daly B, Chan W, Tse KK, Chung HK, Woo KS : Percutaneous treatment of post catheterization massive retroperitoneal hemorrhage. Cathet Cardiovasc Diagn 29 : 40-43, 1993 https://doi.org/10.1002/ccd.1810290109
  11. Quint LE, Holland D, Korobkin M, Cascade PN : Role of femoral vessel catheterization and altered hemostasis in the development of extraperitoneal hematomas : CT study in 44 patients. AJR Am J Roentgenol 160 : 855-858, 1993 https://doi.org/10.2214/ajr.160.4.8456681
  12. Raphael M, Hartnell G : Femoral artery catheterization and retroperitoneal haematoma formation. Clin Radiol 56 : 933-934, 2001 https://doi.org/10.1053/crad.2000.0823
  13. Sharp KW, Spees EK, Selby LR, Zachary JB, Ernst CB : Diagnosis and management of retroperitoneal hematomas after femoral vein cannulation for hemodialysis. Surgery 95 : 90-95, 1984
  14. Sreeram S, Lumsden AB, Miller JS, Salam AA, Dodson TF, Smith RB : Retroperitoneal hematoma following femoral arterial catheterization : a serious and often fatal complication. Am Surg 59 : 94-98, 1993
  15. Swayne LC, Peterson DP, Pohl C : Scintigraphic localization of the bleeding site of a large retroperitoneal hematoma following renal angioplasty. Clin Nucl Med 19 : 490-492, 1994 https://doi.org/10.1097/00003072-199406000-00004
  16. Tomlinson MA, Anjum A, Loosemore T : Retroperitoneal haematoma. Eur J Vasc Endovasc Surg 19 : 558-559, 2000
  17. Trerotola SO, Kuhlman JE, Fishman EK : Bleeding complications of femoral catheterization : CT evaluation. Radiology 74 : 37-40, 1990
  18. Wasay M, Bakshi R, Kojan S, Bobustuc G, Dubey N, Unwin DH : Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis. Stroke 32 : 2310-2317, 2001 https://doi.org/10.1161/hs1001.096192
  19. Witz M, Cohen Y, Lehmann JM : Retroperitoneal haematoma-a serious vascular complication of cardiac catheterisation. Eur J Vasc Endovasc Surg 18 : 364-365, 1999 https://doi.org/10.1053/ejvs.1999.0866

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