At 21 days after femoral catheterization, with a 1‑inch hematoma that has decreased in size and a duplex ultrasound negative for pseudoaneurysm, what activities may the patient safely resume?

Activity Recommendations at 21 Days Post-Femoral Catheterization with Resolving Hematoma

At 21 days post-femoral catheterization with a decreasing 1-inch hematoma and negative duplex ultrasound for pseudoaneurysm, the patient may resume normal daily activities including walking, stair climbing, and sexual activity, but should avoid strenuous physical exertion, heavy lifting (>30 pounds), and vigorous exercise until at least 4-6 weeks post-procedure. 1

Immediate Activity Clearance (Safe at 21 Days)

• Daily walking at a comfortable pace is encouraged and considered safe, as this generates 40-70% of maximum oxygen consumption and poses minimal vascular stress 1
• Stair climbing is permitted, as the ability to climb one flight of stairs without difficulty indicates adequate cardiovascular capacity and healing 1, 2
• Sexual activity may be resumed, provided the patient can climb stairs without difficulty, which serves as a practical functional assessment 1, 2
• Driving is appropriate if the patient is not taking sedating medications and can perform emergency maneuvers comfortably 1
• Light activities of daily living including self-care, light household tasks, and sedentary work are safe 1

Activities to Restrict Until 4-6 Weeks

• Heavy lifting (>30 pounds) should be avoided until complete vascular healing is confirmed, as this creates significant pressure changes that could disrupt the healing arterial puncture site 1, 3
• Vigorous aerobic exercise (running, high-intensity cycling, competitive sports) should be deferred to allow complete healing of the femoral artery access site 1
• Resistance training and weightlifting should be postponed, as these activities generate substantial increases in blood pressure and vascular stress 1, 3

Clinical Rationale

The key consideration here is that while the hematoma is resolving and pseudoaneurysm has been excluded twice, the femoral artery puncture site requires adequate time for complete endothelial healing. The 2011 ACC/AHA/SCAI guidelines emphasize that after uncomplicated percutaneous coronary intervention, patients can resume graduated activity quickly, but this assumes no complications 1. The presence of a hematoma—even a resolving one—indicates some degree of vascular injury beyond routine access site healing.

Small hematomas (<2 cm, approximately 0.8 inches) typically resolve spontaneously and require no specific treatment, but your patient's 1-inch (2.5 cm) hematoma falls just above this threshold 4. The fact that it is decreasing in size and remains negative for pseudoaneurysm on repeat imaging at 21 days is reassuring and indicates appropriate healing trajectory 4.

Monitoring Considerations

• No routine repeat imaging is necessary if the hematoma continues to decrease in size and the patient remains asymptomatic 4
• Patients should monitor for warning signs including sudden increase in hematoma size, new pulsatile mass, development of a bruit or thrill, or new leg pain/swelling that could indicate delayed pseudoaneurysm formation 4
• The risk of delayed pseudoaneurysm formation is low after negative duplex ultrasound at 21 days, as most pseudoaneurysms manifest within the first 2 weeks post-procedure 4

Return to Full Activity Timeline

• At 4-6 weeks post-procedure, if the hematoma has completely resolved and the patient remains asymptomatic, full return to all activities including vigorous exercise and heavy lifting is appropriate 1, 3
• Graded exercise testing may be considered before return to very strenuous occupational or recreational activities to assess functional capacity and ensure no exercise-induced ischemia, particularly if the catheterization was performed for acute coronary syndrome 1
• For patients whose occupation requires heavy physical labor, clearance should be based on complete resolution of the hematoma, absence of tenderness at the access site, and demonstration of adequate exercise tolerance 3

Common Pitfalls to Avoid

• Do not assume that negative imaging at 7 days alone is sufficient for full activity clearance—the 21-day repeat imaging showing continued improvement is important for confirming healing trajectory 4
• Avoid premature return to resistance training or heavy lifting even if the patient feels well, as arterial access sites require 4-6 weeks for complete structural healing despite symptomatic improvement 1, 3
• Do not restrict light activity unnecessarily—excessive bed rest or activity restriction beyond what is medically indicated can lead to deconditioning and does not improve vascular healing 1