Massive retroperitoneal hemorrhage associated with femoral vein cannulation

Takashi Akata, Tetsuzo Nakayama, Tadashi Kandabashi, Kenji Kodama, Shosuke Takahashi

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22 Citations (Scopus)


The right external iliac artery was inadvertently punctured during attempted right femoral vein catheterization. Severe hypotension developed several minutes after the arterial puncture. Concurrently, a large right lower abdominal quadrant swelling (≃5 cm in diameter) became apparent. Laparoscopic observation of the retroperitoneal region immediately revealed massive retroperitoneal hemorrhage. Abdominal computerized tomographic scan indicated development of a huge (≃10 cm in the maximum diameter) retroperitoneal hematoma along the right psoas muscle from the level of the right external iliac vessels up to the level of the upper pole of the right kidney. Consideration of the anatomy of the 'right' femoral and retroperitoneal vessels (ie, mediolateral relationship between the vein and artery) led us to conclude that the site for insertion of the needle was too proximal and the angle for advancement of the needle too low in our patient, allowing the needle to reach and injure the 'incompressible' external iliac artery, thereby causing massive retroperitoneal hemorrhage. Although femoral vein catheterization has generally been considered a relatively safe method of intravenous access, a life-threatening serious complication can occur with the inappropriate technique used in our case.

Original languageEnglish
Pages (from-to)321-326
Number of pages6
JournalJournal of Clinical Anesthesia
Issue number4
Publication statusPublished - Jun 1998

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine


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