title: Should endovascular approach be the first line of treatment for retroperitoneal bleeding with hemodynamic shock following percutaneous intervention? A case series.
abstract: OBJECTIVE
  To report a series of consecutive patients that developed retroperitoneal hemorrhage (RPH) and persistent hypotension treated with endovascular approach.
  
  
  BACKGROUND
  RPH is a rare complication of percutaneous cardiovascular interventions associated with high morbidity and mortality. The standard approach to treat this complication has been a conservative management for stable patients, and urgent vascular surgery for those with persistent hypovolemic shock. Percutaneous endovascular treatment has evolved as an alternative treatment option.
  
  
  METHODS
  We implemented a management algorithm for patients with suspected RPH and persistent hypotension which embraced systematic use of emergency endovascular evaluation and treatment following clinical assessment without the use of non-invasive diagnostic testing. We report a series of 8 consecutive patients that developed RPH with persistent hypotension.
  
  
  RESULTS
  Successful percutaneous treatment was achieved in all cases with the use of a covered stent. No patient required vascular surgery. The average blood transfusion was 3.4 ± 2.7 units per patient. There were no deaths; one patient experienced acute stent thrombosis that was successfully treated via endovascular approach. At 1-year follow-up, no further events were reported.
  
  
  CONCLUSIONS
  The incorporation of a standardized protocol using only clinical evaluation followed by emergency percutaneous approach without delays attributed to non-invasive diagnostic work-up showed to be feasible and associated with favorable outcomes. © 2016 Wiley Periodicals, Inc.
authors: Division of Cardiology, University of Florida Jacksonville, Florida.|Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina.
authors: Ignacio M
authors: IM
authors: Seropian
authors: Division of Cardiology, University of Florida Jacksonville, Florida.
authors: Dominick J
authors: DJ
authors: Angiolillo
authors: Division of Cardiology, University of Florida Jacksonville, Florida.
authors: Martin M
authors: MM
authors: Zenni
authors: Division of Cardiology, University of Florida Jacksonville, Florida.
authors: Theodore A
authors: TA
authors: Bass
authors: Division of Cardiology, University of Florida Jacksonville, Florida.|Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia.
authors: Luis A
authors: LA
authors: Guzman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000792:Angiography; D019091:Critical Pathways; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011474:Prosthesis Design; D012187:Retroperitoneal Space; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome
keywords: algorithm; angioplasty; hemorrhage; retroperitoneal space