Should endovascular approach be the first line of treatment for retroperitoneal bleeding with hemodynamic shock following percutaneous intervention? A case series

Objectives To report a series of consecutive patients that developed retroperitoneal hemorrhage (RPH) and persistent hypotension treated with endovascular approach. Background RPH is a rare complication of percutaneous cardiovascular interventions associated with high morbidity and mortality. The standard approach to treat this complication has been a conservative management for stable patients, and urgent vascular surgery for those with persistent hypovolemic shock. Percutaneous endovascular treatment has evolved as an alternative treatment option. Methods We implemented a management algorithm for patients with suspected RPH and persistent hypotension which embraced systematic use of emergency endovascular evaluation and treatment following clinical assessment without the use of non‐invasive diagnostic testing. We report a series of 8 consecutive patients that developed RPH with persistent hypotension. Results Successful percutaneous treatment was achieved in all cases with the use of a covered stent. No patient required vascular surgery. The average blood transfusion was 3.4 ± 2.7 units per patient. There were no deaths; one patient experienced acute stent thrombosis that was successfully treated via endovascular approach. At 1‐year follow‐up, no further events were reported. Conclusion The incorporation of a standardized protocol using only clinical evaluation followed by emergency percutaneous approach without delays attributed to non‐invasive diagnostic work‐up showed to be feasible and associated with favorable outcomes. © 2016 Wiley Periodicals, Inc.