Retroperitoneal hematoma as a serious complication of endovascular aneurysmal coiling

Abstract

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.

Keywords: Cerebral aneurysm; Coil; Complication; Interventional radiology; Retroperitoneal hematoma.

Fig. 1

Brain computed tomogram 20 hours after endovascular coiling of anterior communicating artery aneurysm. A low density area is seen on the left anterior cerebral artery territory.

Fig. 2

Abdominal computed tomogram at the L3 level 26 hours after endovascular coiling of the anterior communicating artery aneurysm. A huge retroperitoneal hematoma is visible on the right side.