Which complication is associated with femoral arterial access for stent placement?

• A. Pulmonary embolism
• B. Retroperitoneal hemorrhage
• C. Superficial skin infection
• D. Ankle hematoma

Answer: (B)

A puncture of the femoral artery for stent placement can bleed into the retroperitoneal space, making retroperitoneal hemorrhage the most likely complication. When the arterial access point is high or anticoagulation is used, blood can track into the retroperitoneum rather than forming a visible groin hematoma. This concealed bleed may cause sudden hypotension, back or flank pain, abdominal distension, and a drop in hemoglobin, with external bleeding appearing minimal or absent. Because the bleeding isn’t easily compressible at the groin, it can be hard to control with simple local pressure, making it a feared and time-sensitive complication. Prevention focuses on ultrasound-guided access below the inguinal ligament, careful sheath size selection, meticulous hemostasis, and appropriate anticoagulation management, along with post-procedure monitoring for signs of hemorrhage. If suspected, rapid stabilization, imaging to confirm the bleed, reversal of anticoagulation as needed, blood products, and potentially surgical or endovascular intervention are required. Pulmonary embolism, superficial skin infection, and ankle hematoma are less characteristic of femoral arterial access complications in this context.