When can I climb stairs after a post‑catheterization femoral hematoma?

When Can I Climb Stairs After a Post-Catheterization Femoral Hematoma?

You should avoid climbing stairs for at least 48–72 hours after developing a femoral hematoma, and only resume stair climbing after 7–10 days once a follow-up duplex ultrasound confirms the hematoma is stable or resolving and no pseudoaneurysm has formed. 1

Immediate Post-Hematoma Period (First 48–72 Hours)

Strict bed rest is mandatory during the initial 48–72 hours to allow clot stabilization and prevent mechanical disruption of the arterial puncture site. 1 This period is critical because:

• Hip flexion during stair climbing raises intra-abdominal and femoral pressures, which can stress the healing arterial wall and potentially convert a stable hematoma into a communicating pseudoaneurysm 1
• Hip flexion creates a "pumping" effect on the femoral artery that may promote bleeding 2
• More than 60% of catheter-related femoral pseudoaneurysms are missed on physical examination alone, making imaging essential before activity advancement 3, 4

Days 4–7: Limited Activity Only

Brief sitting (≤15–20 minutes) may be allowed after 72 hours only if serial examinations show the hematoma is stable or decreasing in size, there is no new pulsatile quality, and you report no increasing pain or expanding mass. 1 However, stair climbing remains prohibited during this period because:

• The repetitive hip flexion and weight-bearing stress of stair climbing far exceeds the mechanical demands of brief sitting 1
• Even stable-appearing hematomas can harbor occult pseudoaneurysms detectable only by Doppler ultrasound 1

Week 2 and Beyond: Gradual Activity Resumption

Gradual increase in activity, including stair climbing, is permissible once a follow-up duplex ultrasound at 7–10 days confirms no pseudoaneurysm formation. 1 This imaging checkpoint is non-negotiable because:

• Physical examination alone is insufficient to exclude pseudoaneurysm; objective imaging confirmation of hematoma stability is required 1
• Even small hematomas can harbor occult pseudoaneurysms detectable only by Doppler ultrasound 1
• Conversion to a pulsatile mass signals pseudoaneurysm formation and mandates urgent ultrasound-guided thrombin injection or surgical repair 1

Critical Red Flags Requiring Immediate Medical Attention

Stop all activity and seek immediate medical evaluation if you develop:

• New pulsatile mass or thrill at the groin site (signals pseudoaneurysm formation) 1, 5
• Expanding hematoma despite bed rest (suggests ongoing arterial bleeding) 1
• Compressive symptoms: numbness, weakness, venous congestion, or severe pain (may indicate femoral nerve neuropathy or venous thrombosis) 1, 6
• Progressive skin changes: increasing ecchymosis, skin tension, or overlying erythema (may indicate impending rupture) 1

Special Considerations for Antiplatelet Therapy

If you received a coronary stent, continue your dual antiplatelet therapy (aspirin plus clopidogrel or another P2Y12 inhibitor) as prescribed—do not stop these medications to "help the hematoma heal." 1 The rationale is critical:

• Stent thrombosis carries a 25–30% mortality rate, which far outweighs the local bleeding risk 1
• Low-dose aspirin does not prevent spontaneous thrombosis of small vascular injuries; high closure rates are maintained despite antiplatelet therapy 1
• The combination of aspirin therapy and mechanical stress from stair climbing creates additive risk, making the 7–10 day imaging checkpoint especially important 1

Surveillance Protocol Before Resuming Stairs

Your healthcare team should implement:

• Weekly clinical assessments measuring hematoma size, palpating for pulsatility, and auscultating for new bruits 1
• Duplex ultrasound at 7–10 days to document stability and exclude delayed pseudoaneurysm formation before clearing you for stair climbing 1
• Duplex ultrasound at 1 month for all femoral hematomas to document complete resolution 1

Common Pitfalls to Avoid

• Do not resume stair climbing based solely on feeling better—objective imaging confirmation is required 1
• Do not rely on hematoma size alone—even small hematomas can harbor occult pseudoaneurysms 1
• Do not assume a non-pulsatile mass excludes pseudoaneurysm—thrombosed pseudoaneurysms may be non-pulsatile yet still require definitive treatment 1
• Do not discontinue aspirin—the cardiovascular risk of stopping aspirin far exceeds the bleeding risk from a stable hematoma 1