S. Hung Fong1, S. Jaafar1, S. Misra1,2, V. Narasimha1 1Brandon Regional Hospital,GME – Surgery,Brandon, FL, USA 2HCA,West Florida,Tampa, FL, USA
Introduction: Trans-femoral catheterization is a relative safe, minimally invasive procedure to assess coronary arteries and limb ischemia and subsequently revascularization with the placement of a stent or balloon angioplasty. However, complications can still manifest as bleeding, infection, hematoma, pseudoaneurysm, arteriovenous (AV) fistula formation and femoral artery thrombosis. In spite of appropriate use of vascular closing devices (VCD) and its lower rate of vascular complications as compared to manual compression, there have also been reported rare cases of scrotal hematoma following post trans-femoral catheterization for coronary intervention. We report a similar case of scrotal and right groin hematoma post trans-femoral vascular access, but for evaluation of limb ischemia.
Methods: A case report was described of a 72-year-old male who underwent transfemoral catheterization for evaluation of limb ischemia complicated by groin and scrotal hematoma that was successfully treated conservatively. Four different reported cases were found on Pubmed, Google scholar and Cohchrane on scrotal hematoma associated with transfemoral access approach. Several characteristic were compared from each reported cases including sign and symptoms of hemorrhagic shock, history of use of anticoagulation, use of vascular closing device, whether mechanical compression was done, the injured vessel involved, the level of drop in hemoglobin and the mode of management. Our case report also included all of these characteristic for comparison with the other four reported cases
Results: Three out of four cases present with hemorrhagic shock, and reported use of VCD; two cases reported use of anticoagulation; the most common vessel injured is the common femoral artery; an average of 2 g/dL of hemoglobin lead to symptoms of hemorrhagic shock; three cases required groin exploration and one case managed conservatively.
Conclusion: Scrotal hematoma can present with or without signs of hemorrhagic shock. Symptoms most commonly present are groin and scrotal pain associated with swelling and ecchymosis. Scrotal hematoma is a rare complication, but the increasing popularity of transfemoral access approach lead to increase risk of urologic complications, warranting a urologic consultation and groin/genital exploration. Identifying those may be at high risk for this complication may prevent significant morbidity and mortality in these patients.
