Page 37 - Virtual Vascular

Retroperitoneal Bleeding after

Endovascular Procedure

Learning points:

• Iatrogenic retroperitoneal haemorrhage may be due to puncture site

injury or perforation of major or minor arteries during endovascular
procedures

• Spontaneous haemorrhage occurs in patients who are on heparin, anti-
platelet agents, or anticoagulants (such as NOAC or integrin). These drugs

may be used in endovascular procedures.

• In haemodynamicaaly stable patients, CT arteriography is important to
delineate sites of extravasation

• Stable patients can be managed with closed observation in high
dependency units, with fluid resuscitation, correction of coagulopathy, or

transfusion of blood products

• Endovascular intra-arterial selective embolisation or deployment of stent-

grafts to cover the injured vessel should be considered if the CT scan
identifies the site of bleeding

• Open repair of retroperitoneal bleeding vessels is reserved for patients
with haemodynamic instability, or failure of the above treatment options