Case report

Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

Naoto Fukunaga^1,4 , Shizuo Ikeyama² , Jyunichiro Satomi³ and Koichi Satoh¹

¹  Department of Neurosurgery, Tokushima Red Cross Hospital, 103 Irinoguchi, Komatsushima-cho, Komatsushima-shi, Tokushima 773-8502, Japan

²  Department of Radiology, Tokushima Red Cross Hospital, 103 Irinoguchi, Komatsushima-cho, Komatsushima-shi, Tokushima 773-8502, Japan

³  Department of Neurosurgery, Tokushima University Hospital, 50-1-2 Kuramoto-cho, Tokushima-shi, Tokushima 770-8503, Japan

⁴  Current address: Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 4-6 Minatojimanakamachi, Chuo-ku, Kobe-shi, Hyogo 650-0046, Japan

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World Journal of Emergency Surgery 2009, 4:39doi:10.1186/1749-7922-4-39

Published:	12 November 2009

Abstract

Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS), but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.