Kent K C, Moscucci M, Mansour K A, DiMattia S, Gallagher S, Kuntz R, Skillman J J
Harvard Medical School, Boston, MA.
J Vasc Surg. 1994 Dec;20(6):905-10; discussion 910-3. doi: 10.1016/0741-5214(94)90227-5.
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.
腹膜后血肿是心脏导管插入术后一种不常见但可能严重的并发症。确定了这种医源性并发症的易感因素、典型表现和临床病程，并明确了手术在其治疗中的作用。
对5年期间9585例股动脉导管插入术进行回顾性研究，以识别和评估所有发生腹膜后出血的患者。
45例患者发生腹膜后血肿（总发生率0.5%），冠状动脉支架置入术后发生率最高（3%）。在接受冠状动脉支架置入术的患者组中，该并发症的统计学显著预测因素包括鞘管拔除方案、女性性别、最低血小板计数和过度抗凝。体征和症状包括100%的腹股沟上压痛和饱满感、64%的严重背部和下腹部疼痛以及36%的股神经病变。大多数患者仅通过输血成功治疗。7例患者（16%）需要手术；4例在导管插入术后早期出现对容量复苏无反应的低血压；3例血细胞比容水平逐渐下降导致在导管插入术后24至72小时进行手术。
心脏导管插入术后的腹膜后血肿通常仅通过输血治疗。一小部分对容量复苏无反应而出现低血压的患者需要紧急手术。
