A 58 yo M develops abdominal pain and hypotension 12 hours following stent placement to the L common iliac and L superficial femoral artery for limb ischemia. Both common femoral arteries were accessed during the procedure. A CT is obtained. What's the diagnosis? (scroll down for answer)

Answer: Active extravasation from R iliac artery w/ large retroperitoneal hematoma

• In image above- Yellow arrow shows active extravasation, while green circle shows developing RP hematoma
• Retroperitoneal hematoma formation is a rare but serious complication of femoral artery catheterization 
• Symptoms may include: groin pain/tenderness, severe back pain or lower quadrant abdominal pain, or femoral neuropathy 
• Any anticoagulation should be reversed
• Patient should be resuscitated with blood products early
• Surgical emergency requiring prompt operative repair- immediate consult to vascular surgery/IR depending on resources available