Korean Circ J.  2016 Mar;46(2):256-259. 10.4070/kcj.2016.46.2.256.

Spontaneous Bleeding from Internal Pudendal Artery associated with Abciximab after Primary Percutaneous Coronary Intervention: Successful Treatment with Percutaneous Gel-Foam Embolization

• Lee SE
• Jo HB
• Moon HH
• Oh DJ
• Kwon KH
• Kwon JH
• Kim YK
• Kim YS

• KMID: 2344478
• DOI: http://doi.org/10.4070/kcj.2016.46.2.256

Abstract

We describe a case of spontaneous bleeding from a branch of the right internal pudendal artery that resulted in massive scrotal swelling in a patient who had underwent primary percutaneous coronary intervention with the use of abciximab concurrent with conventional anticoagulation and dual antiplatelet therapies for the treatment of acute ST-segment elevation myocardial infarction. This unusual complication was promptly identified by percutaneous peripheral arteriography and successfully treated with gel-foam embolization.

Keyword

Bleeding; Percutaneous coronary intervention; Abciximab

MeSH Terms

Angiography
Arteries*
Hemorrhage*
Humans
Myocardial Infarction
Percutaneous Coronary Intervention*

Figure

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  Fig. 1 Massive swelling with discoloration of scrotal and perineal regions suggesting bleeding complication on physical examination.

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  Fig. 2 Right internal iliac arteriogram illustrating the contrast extravasation (arrow) from a distal branch of the right internal pudendal artery.

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  Fig. 3 Repeat right internal iliac arteriogram confirming no extravasation of contrast (arrow) after gel-foam embolization.

Reference

1. De Luca G, Suryapranata H, Stone GW, et al. Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. JAMA. 2005; 293:1759–1765.

2. Cote AV, Berger PB, Holmes DR Jr, Scott CG, Bell MR. Hemorrhagic and vascular complications after percutaneous coronary intervention with adjunctive abciximab. Mayo Clin Proc. 2001; 76:890–896.

3. Khanlou H, Eiger G, Yazdanfar S. Abciximab and alveolar hemorrhage. N Engl J Med. 1998; 339:1861–1863.

4. Cherukuri M, Pershad A. Late spontaneous epigastric arterial bleeding associated with abciximab: successful percutaneous treatment with coil gel-foam embolization. J Invasive Cardiol. 2002; 14:692–693.

5. Dorval JF, Soulez G, Berry C, Bonan R. Management of a spontaneous renal capsule hematoma following cardiac catheterization involving use of a platelet glycoprotein IIb/IIIa inhibitor: a case report. Catheter Cardiovasc Interv. 2007; 69:994–997.

6. American College of Emergency Physicians. Society for Cardiovascular Angiography and Interventions. O'Gara PT, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 61:e78–e140.

7. Dziewierz A, Rakowski T, Dudek D. Abciximab in the management of acute myocardial infarction with ST-segment elevation: evidence-based treatment, current clinical use, and future perspectives. Ther Clin Risk Manag. 2014; 10:567–576.

8. Iqbal Z, Cohen M, Pollack C, et al. Safety and efficacy of adjuvant glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention performed from the radial approach for acute ST segment elevation myocardial infarction. Am J Cardiol. 2013; 111:1727–1733.

9. Parodi G, De Luca G, Moschi G, et al. Safety of immediate reversal of anticoagulation by protamine to reduce bleeding complications after infarct artery stenting for acute myocardial infarction and adjunctive abciximab therapy. J Thromb Thrombolysis. 2010; 30:446–451.