From the Guidelines
Post-catheterization hematomas are generally managed with manual compression, adjustment of compression band pressure, or repositioning of the compression band to a more proximal location, as outlined in the American Heart Association's scientific statement on transradial coronary angiography and intervention in acute coronary syndrome 1. When managing post-cath hematoma, it is essential to consider the potential complications, such as arterial perforation, pseudoaneurysm, or compartment syndrome.
- The incidence of major vascular complications after transradial artery access is low, but reported complications include hematoma, perforation, and RA spasm 1.
- Hematoma formation proximal to the access site may indicate arterial perforation, usually of a side branch, and forearm angiography at the conclusion of the case is strongly advised in such cases 1.
- In cases of severe bleeding during or after the procedure, extrinsic compression with an elastic bandage or blood pressure cuff inflated to subocclusive pressure can achieve hemostasis 1.
- Surgical repair of the laceration and evacuation of hematoma may be required in rare occasions when recognized very late or when hemostasis cannot be achieved with the above measures because of an arterial laceration 1. Proper post-procedure care, including bed rest and avoiding heavy lifting or strenuous activity, helps prevent this complication.
- Patients on anticoagulants should be monitored more closely for potential larger hematomas 1.
- Most hematomas resolve within 1-2 weeks without intervention, but patients should monitor the site for increasing size, severe pain, numbness, or color changes in the limb, which may indicate a more serious complication requiring immediate medical attention.
From the Research
Post Catheterization Hematoma
- A post catheterization hematoma is a potential complication of catheterization procedures, which can be caused by anticoagulant therapy 2.
- The use of anticoagulants, such as warfarin, can increase the risk of bleeding and hematoma formation 3, 4.
- Ultrasound therapy has been shown to be effective in treating hematomas, including those caused by catheterization 3.
- Contrast-enhanced ultrasound (CEUS) can be used to guide percutaneous thrombin injection (PTI) to control active extravasation and promote hematoma resorption 4.
- The sonographic appearance of a hematoma can affect the ease of aspiration, with hypoechoic hematomas being easier to aspirate than those with other echotextures 5.
- CEUS has been shown to be a promising alternative to multidetector computed tomographic (MDCT) imaging for detecting active hemorrhage in patients with soft-tissue hematomas, including those caused by catheterization 6.
Treatment Options
- Ultrasound-guided aspiration of hematomas is a safe and effective procedure, and the sonographic appearance of a hematoma should not dissuade one from trying to aspirate it 5.
- PTI under CEUS guidance can be an effective treatment for controlling active extravasation and promoting hematoma resorption 4.
- The choice of treatment for a post catheterization hematoma will depend on the individual patient's condition and the severity of the hematoma.
Diagnosis and Imaging
- CEUS can be used to detect active hemorrhage and guide treatment in patients with soft-tissue hematomas, including those caused by catheterization 4, 6.
- Ultrasound evaluation can be used to assess the size and location of a hematoma, as well as to guide aspiration or other treatment procedures 3, 5.
- MDCT imaging can also be used to diagnose and evaluate hematomas, but CEUS may provide superior diagnostic information in some cases 6.