Acosta JFR. et al., 2026: Retroperitoneal Hemorrhage After Transradial Cardiac Catheterization in a Patient With Recent Right Kidney Lithotripsy.

Acosta JFR, Suárez JM, Núñez DRB.
JACC Case Rep. 2026 Feb 25;31(8):106719. doi: 10.1016/j.jaccas.2025.106719

Abstract

Background: Retroperitoneal hemorrhage is traditionally associated with femoral access during cardiac catheterization. However, with the increased use of transradial access, the incidence of retroperitoneal hemorrhage has decreased.

Case summary: A 62-year-old man with chest pain underwent an elective coronary angiography via right radial artery. During recovery, he developed abdominal pain with hypotension and tachycardia. Abdominal contrast-enhanced computed tomography revealed a grade 4 subcapsular hematoma in the right kidney, which was managed conservatively. Further history revealed he had undergone an uneventful right kidney lithotripsy 2 weeks before the elective coronary angiography.

Discussion: To our knowledge, this is the first documented case of a retroperitoneal hemorrhage after a transradial cardiac catheterization in a patient with recent history of extracorporeal shock wave lithotripsy for kidney stones.

Take-home message: This case underscores the importance of a detailed history, particularly when patients have undergone recent renal procedures, including extracorporeal shock wave lithotripsy, that could predispose them to complications.

Comment Hans-Göran Tiselius

The authors describe a case of retroperitoneal bleeding associated with trans radial cardiac catheterization. The explanation of this complication, as also emphasized by the authors, is the administration of 5000 units of heparin at the time of catheterization. Most certainly the patient had developed subclinical hematoma during the SWL-procedure. Apparently, the hematoma increased when anti-coagulation started. Usually, a dose of 2500 -5000 U of heparin is tolerated, but this patient also had a history of hypertension, and the anticoagulation most certainly started a new bleeding in the hematoma.

After SWL it is wise to be careful with anticoagulation. Although, as mentioned, a dose of 5000 U of heparin might be acceptable, a lower dose is recommended particularly in patients with a history of hypertension.

In this patient it is not the catheterization that caused the bleeding, but administration of heparin close to a recent SWL.

Hans-Göran Tiselius