Retroperitoneal Hematoma After Percutaneous Femoral Vein Catheterization: A Rare Complication Volume 59- Issue 5

Honglan Ma¹, Yimeng Gao^1,2, Xia Ye¹ and Juan Li¹*

• ¹Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Medical University, China
• ²Department of Cardiovascular Medicine, Xi’an Medical University, China

Received: November 27, 2024; Published: December 05, 2024

*Corresponding author: Juan Li, Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi 710077, China

DOI: 10.26717/BJSTR.2024.59.009357

Abstract PDF

Percutaneous femoral vein catheterization is a common routine procedure for hospitalized patients, and this procedure is not without complications. Retroperitoneal hematoma due to vascular penetrating injury, although rare, can still occur. This report describes a 60-year-old woman with heart failure and chronic renal failure was treated with percutaneous femoral vein catheterization for continuous renal replacement therapy. But unfortunately, retroperitoneal hematoma complication caused by percutaneous femoral vein catheterization with a central venous catheter (CVC) tip protruding through the iliac vein. Then the patient was treated with emergency femoral venography and femoral vein stent implantation.

Keywords: Retroperitoneal Hematoma; Percutaneous Femoral Vein Catheterization; Vein Injury; Learning Points for Clinicians

Percutaneous femoral vein catheterization is a common routine procedure for hospitalized patients, and this procedure is not without complications. Retroperitoneal hematoma due to vascular penetrating injury, although rare, can still occur. This complication can be largely avoided by ultrasound, attention to puncture force and angle.

A 60-year-old woman with heart failure and chronic renal failure was admitted to our department and treated with percutaneous femoral vein catheterization for continuous renal replacement therapy (CRRT). But 2 days later, when the patient was physical examined due to persistent pain in the posterior lumbar region, large subcutaneous ecchymosis could be seen in the posterior lumbar region. Urgent blood test and abdominal CT scan were performed, suggesting she had decreased hemoglobin, a huge retroperitoneal hematoma, pelvic effusion, and a central venous catheter (CVC) tip outside the iliac vein (Figure 1). Considering the penetrating vein injury by CVC, the patient was treated with emergency femoral venography to clarify the diagnosis, and then was treated with femoral vein stent implantation (Figure 2). After the operation, the hemoglobin gradually increased and the hematoma gradually decreased.

Figure 1

Figure 2

Retroperitoneal hematoma is a life-threatening disease with a high mortality rate from retroperitoneal hiatus hemorrhage, and early diagnosis and proper treatment are crucial [1]. Retroperitoneal hematoma has a variety of causes, while medical vascular injuries and retroperitoneal hematoma complications caused by percutaneous femoral vein catheterization and surgery are relatively rare, but can carry a heavy burden on patients and clinical staff [2]. One of the best ways to manage postoperative complications is to prevent them from occurring in the first place, and a great deal of research has been invested in predicting postoperative complications over the past few decades [2,3]. We report this case of penetrating extremity vascular injuries, retroperitoneal hematoma due to malpractice, and we believe that the most important cause of this complication is inappropriate force and angle of puncture, which can easily lead to vascular injuries when punctured with too much force and at too large angle.

A meta-analysis by Sobolev, et al. [4] showed a 60% reduction in the likelihood of major vascular complications, and a 66% reduction in the likelihood of minor vascular complications when ultrasound- guided femoral vein access was used in electrophysiologic procedures. So ultrasound guidance reduces the risk of bleeding from vascular access, especially in patients receiving anticoagulation. Avoiding complications of clinical procedures does require a multifaceted approach that includes adequate preparation, strict adherence to guidelines, ongoing monitoring and evaluation and emergency management, patient communication and education, and continuous learning and improvement.

1. D Janák VR (2021) Retroperitoneal hematoma: diagnosis and treatment. Perspectives in Surgery 100(12): 569-575.
2. Rao A, Ratner M, Zhang J, Wiske C, Garg K, et al. (2024) The substantial burden of iatrogenic vascular injury on the vascular surgery workforce at an academic medical center. J Vasc Surg 80(2): 373-378.
3. Wang S (2023) Massive Pelvic Hematoma After Atrial Septal Defect Closure Via Femoral Vein Cannulation. The heart surgery forum 26(2): E189-E191.
4. Sobolev M, Shiloh AL, Di Biase L, Slovut DP (2017) Ultrasound-guided cannulation of the femoral vein in electrophysiological procedures: a systematic review and meta-analysis. Europace 19(5):850-855.