Surreal illustration of vascular network with heart.

Unexpected Turn: When a Heart Procedure Leads to an Abdominal Wall Hematoma

Elliot Brynn in Health & Wellness November 2025 • 4 min read.

"Discover a rare vascular complication following percutaneous coronary intervention and how prompt recognition can save lives."

Vascular complications are known risks when undergoing percutaneous coronary intervention (PCI) via the femoral artery. These complications increase hospital stays, costs, and can even lead to longer-term issues such as myocardial infarction. While bleeding, pseudoaneurysm formation, and other femoral injuries are more commonly discussed, an abdominal wall hematoma remains a rare and often surprising condition.

An abdominal wall hematoma can feel like an acute abdominal issue, causing sudden pain and distress. What makes it particularly concerning is that it's not always immediately obvious. Recognizing this rare complication is crucial for timely and effective management.

In this article, we delve into a case of a 73-year-old woman who developed an abdominal wall hematoma following a PCI. This case underscores the importance of vigilance and understanding the potential unexpected complications of even routine procedures.

The Unexpected Complication: A Case Study

Surreal illustration of vascular network with heart.

A 73-year-old woman with a history of hypertension, diabetes mellitus, and chronic kidney disease presented to the emergency department with severe dyspnea. After initial stabilization, she underwent coronary angiography to evaluate potential ischemic heart disease. The procedure itself seemed straightforward, but events took an unforeseen turn.

During the procedure, a guidewire unintentionally entered the circumflex iliac artery. While the guidewire was promptly removed and the procedure continued without immediate issues, a delayed complication arose. Fourteen hours post-PCI, the patient reported right abdominal pain and swelling, accompanied by a drop in blood pressure.

Prompt Recognition: Recognizing the issue early was crucial.
Fluid Resuscitation: Hydration and blood transfusions were administered.
Imaging: CT angiography revealed a right lateral abdominal wall hematoma.
Observation: The patient was closely monitored, avoiding further invasive interventions.

The patient's condition stabilized with conservative management, including hydration, blood transfusions, and close observation. After several days, the abdominal pain subsided, and the patient was eventually discharged. This case highlights that even seemingly uneventful procedures can lead to rare complications that require careful management.

Preventing and Managing Vascular Complications

This case serves as a reminder of the importance of vigilance following PCI procedures. While abdominal wall hematomas are rare, recognizing the risk factors and symptoms can lead to prompt diagnosis and appropriate management. Using fluoroscopy during femoral artery puncture, carefully advancing guidewires, and closely monitoring patients post-procedure are key strategies in preventing such complications. When complications do arise, a staged approach to PCI, along with careful observation, can ensure patient safety and well-being.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4070/kcj.2016.46.3.408, Alternate LINK

Title: Abdominal Wall Hematoma As A Rare Complication Following Percutaneous Coronary Intervention

Subject: Cardiology and Cardiovascular Medicine

Journal: Korean Circulation Journal

Publisher: The Korean Society of Cardiology

Authors: In Tae Moon, Jeong Hun Shin, Young Seok Sohn, Ji Young Lee, Hwan Cheol Park, Sung Il Choi, Soon Gil Kim, Ji Young Oh

Published: 2016-01-01

Everything You Need To Know

What does an abdominal wall hematoma feel like following percutaneous coronary intervention (PCI), and why is it a concern?

An abdominal wall hematoma following percutaneous coronary intervention (PCI) presents as acute abdominal pain and swelling. It's concerning because it's not always immediately obvious and can be a rare vascular complication of PCI, especially when accessed through the femoral artery. Recognizing the symptoms promptly is crucial for effective management.

What key strategies can prevent vascular complications, such as abdominal wall hematomas, during percutaneous coronary intervention (PCI)?

During PCI, several strategies can prevent vascular complications like abdominal wall hematomas. These include using fluoroscopy during femoral artery puncture, carefully advancing guidewires to avoid unintended arterial entry such as into the circumflex iliac artery, and closely monitoring patients post-procedure for any signs of bleeding or hematoma formation. A staged approach to PCI can also help minimize risks.

In the case where a patient developed an abdominal wall hematoma after PCI, what management steps were taken to stabilize the patient's condition?

In the presented case, after a guidewire unintentionally entered the circumflex iliac artery during PCI, the patient developed an abdominal wall hematoma. The management included prompt recognition of the issue, fluid resuscitation with hydration and blood transfusions, imaging with CT angiography to confirm the hematoma, and close observation. Further invasive interventions were avoided, and the patient stabilized with this conservative approach.

What are the potential implications and risks associated with vascular complications like an abdominal wall hematoma following percutaneous coronary intervention (PCI)?

Vascular complications like an abdominal wall hematoma can lead to increased hospital stays, higher medical costs, and potential longer-term issues. If not promptly recognized and managed, such complications may exacerbate existing conditions such as myocardial infarction. Vigilant post-operative care and quick intervention are essential to mitigate these risks and ensure patient well-being. While bleeding and pseudoaneurysm formation are frequently discussed, abdominal wall hematomas can be just as life-threatening.

Why is it important to be aware of rare vascular complications like abdominal wall hematomas when undergoing percutaneous coronary intervention (PCI)?

Percutaneous coronary intervention (PCI) via the femoral artery carries inherent risks, including vascular complications. While conditions like bleeding and pseudoaneurysm formation are more commonly discussed, rare events such as an abdominal wall hematoma can occur. These complications highlight the importance of understanding the anatomy, employing careful technique during the procedure, and maintaining vigilant post-operative monitoring to ensure patient safety and minimize potential adverse outcomes.