Page 35 - Virtual Vascular Vol 11

How would you manage this patient?

In view of recent transfemoral arterial intervention and the obvious

bruise, the top differential diagnosis would be hypovolaemic shock.

Patients who has femoral arterial puncture may develop:
pseudoaneurysm, groin or retroperitoneal haematoma or

haemorrhage. The risk of bleeding is exacerbated by the double-anti
platelet agents (e.g. aspirin, clopidogrel, or ticagrelor) and heparin,

which are becessary after coronary stents.

First step of management is resuscitation with continuous

assessment of vital signs, preferably in a high dependency unit

(HDU) or coronary care centre (CCU). Patient needs large bore
cannulae with infusion of colloids and blood products (packed cells)

in preference to crystalloids. Coagulopathy and thrombocytopenia

need to be given.

Care must be taken to avoid fluid overload in frail cardiac patients,

and platelet transfusion may cause coronary stent thrombosis.
Multidisciplinary approach with vascular surgeons and cardiologists

is mandatory.

When the patient is adequately resuscitated. A CT scan is indicated

to rule out active extravasation and to document the site or
haemorrhage and the extent of haematoma.

If there is active extravasation of contrast, patient needs
intravascular embolization or open surgical exploration with repair

or plication of bleeding vessels and evacuation of hematoma.

There was an urgent consult from medical ward for an elderly patient who developed a
large left thigh ecchymosis 5 days after a coronary intervention via the left femoral artery 35
access. The patient was hypotensive and tachycardic. The patient was on double anti-

platelet agent and the Hb was 6.5g/dL.