From the Guidelines
A hematoma following an angiogram can lead to significant complications, including unsuccessful cannulation attempts, poorer AVF maturation outcomes, and the need for placement of a CVC, emphasizing the importance of prompt recognition and management. The complications of a hematoma after an angiogram can be severe, causing significant discomfort and distress to patients, and potentially affecting their ability to have a functioning dialysis access in the future 1. Some of the potential complications include:
- Infiltration injury, which can lead to frequent imaging, interventions, and prolonged need for a CVC
- Unsuccessful cannulation attempts, associated with poorer AVF maturation outcomes
- Venous outflow stenosis, which may require a referral for a diagnostic angiogram
- The need for placement of a CVC and deferral of further AV access cannulations until the hematoma is resolved, which can last up to 3 months. It is essential to apply direct pressure to the bleeding site, exercise care not to occlude the AV access outflow distal to the bleeding site, and consider the use of a skin suture if necessary, as outlined in the kdoqi clinical practice guideline for vascular access: 2019 update 1. In cases where a "bad stick" results in a significant hematoma, it is crucial to prioritize the patient's safety and consider the potential need for further intervention, such as placement of a CVC, to prevent further complications. Overall, the management of a hematoma following an angiogram requires careful attention to detail and a patient-centered approach to minimize the risk of complications and ensure the best possible outcomes.
From the Research
Complications of Hematoma after Angiogram
The development of a hematoma is a common complication after coronary angiography (CA) and percutaneous coronary intervention (PCI) via the femoral artery 2. Several factors have been identified as predictors of hematoma development, including:
- Women
- Systolic blood pressure >160 mm Hg
- Artery puncture >1
- Sheath time >16 min
- ACT > or = 175 s
- Glycoprotein (GP) IIB/IIIa inhibitors
- Low Molecular Weight Heparin before procedure
- Personnel change during compression
- Anti-coagulant-treatment before procedure
Risk of Rebleeding and Hematoma Formation
The risk of rebleeding and hematoma formation after angiography is higher when using seven French catheters compared to five or six French catheters 3. However, the use of a light dressing with thin transparent tape (Tegaderm) instead of a conventional tight/pressure dressing with an elastic adhesive bandage (Tensoplast) can reduce patient discomfort without increasing the risk of bleeding complications 4.
Optimal Hemostatic Band Duration
The optimal duration of hemostatic compression post transradial access is controversial, with longer durations increasing the risk of radial artery occlusion (RAO) and shorter durations increasing the risk of access site bleeding or hematoma 5. A duration of 2 hours is typically used, but a mixed treatment comparison meta-analysis of randomized trials found that this duration offers the best balance for efficacy and safety.
Predictors of Bleeding Complications
High blood pressure has been identified as a predictor of bleeding complications after elective coronary angiography using the femoral approach 6. Female gender is also an independent predictor of bleeding complications. Reducing high systolic blood pressure before elective CA may help minimize the risk of bleeding complications.