Presentation and Management of Retroperitoneal Hematomas: Recent Vascular Intervention and Anticoagulation do not Predict the Need for Intervention
Michael E. Barfield, MD, Gregory G. Westin, MD, John F. Charitable, MD, Evan J. Johnson, MD, Glenn R. Jacobowitz, MD, Thomas S. Maldonado, MD, Caron B. Rockman, MD.
New York University, New York, NY, USA.
Vascular surgeons are frequently asked to manage retroperitoneal hematomas (RPH). However, the risks factors predicting the need for endovascular or surgical management are not well defined in the literature. The goal of our study was to review the presentation and management of a consecutive cohort of such patients at a single institution over a three-year period.
Patients with RPH diagnosed radiologically by CT scan over a recent three-year period at our tertiary care center were reviewed. RPH that occurred directly as a result of recent surgery (e. g. post-colectomy) or as a result of trauma were excluded. Patient demographics, risk factors, and hospital course were reviewed.
A cohort of 54 patients was identified (53.7% female, mean age 71 years). 68.8% of cases were diagnosed in the inpatient setting, 18.8% in the ED, and 12.5% as outpatients. Comorbidities included diabetes in 26.9%, ESRD in 7.8%, malignancy in 20.5%, and known coagulopathy in 4.9%. A recent procedure involving vascular intervention was performed in 57.4%, with the most common being cardiac catheterization. 63% of patients were on anticoagulation therapy, most commonly for atrial fibrillation (33.3%), and the most common agent being intravenous heparin. 57.4% of patients were on antiplatelet therapy. Indications for CT scan included pain (42.6%), hypotension (35.2%), and clinical concern for bleeding (75.9%). Ultimately 8 patients (15.1%) required intervention: 6 patients (11.3%) required endovascular intervention consisting of coil embolization or stent-graft placement, and 3 patients (5.7%) required open surgical management, with one patient requiring both endovascular and subsequent surgical management. Patients with recent intervention did not have an increased requirement for intervention compared to patients with spontaneous RPH (18.5% vs. 11.5%, p=NS ), nor did patients on anticoagulation compared to patients not on anticoagulation (11.8% vs. 21.1%, p=NS). 17.8% of patients expired on the same admission on which RPH was diagnosed.
A meaningful proportion of patients with RPH require intervention to control hemorrhage. In this series we were unable to identify predictors which led to intervention. The majority of patients requiring intervention can be treated successfully with endovascular approaches. A significant proportion of these patients expired on the same hospitalization, indicating that RPH occurs in a patient population with significant medical comorbidities.
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