Circulatory collapse after sheath removal in transfemoral transcatheter aortic valve implantation
Keywords:TAVI, retroperitoneal hemorrhage, complications, abdominal compartment syndrome, diagnosis
An 87-year-old woman (146 cm, 42.2 kg) underwent transfemoral transcatheter aortic valve implantation (TF-TAVI) uneventfully. The patient successfully underwent emergency endovascular aortic repair using a covered stent to seal the vascular rupture. In order to treat the abdominal compartment syndrome, approximately 2,700 ml of haemorrhagic fluid was evacuated using ultrasound-guided abdominal paracentesis. RPH is a rare, although severe, complication of TF-TAVI, and has been reported in 0%–2.2% of cases. Although the best management protocol for RPH remains controversial, conservative management should only be applied in stable patients. In cases of uncontrollable, ongoing bleeding, endovascular treatment or embolization should be the method of choice. Open surgical intervention is rarely require. Nevertheless, if treated inappropriately, the mortality rates remain high.
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Chan YC, Morales JP, Reidy JF, et al. Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? The International Journal of Clinical Practice 2008; 62: 1604-13. DOI: 10.1111/j.1742-1241.2007.01494.x.
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