Assistant Professor of Radiology University of Kentucky University of Kentucky College of Medicine Lexington, Kentucky, United States
Background: Pelvic retroperitoneal hematomas may cause mass effects, pressure symptoms, or become secondarily infected. Percutaneous management using image-guided drainage catheter placement. However, this approach is less than ideal and is limited by poor drainage efficiency of thick thrombus material, the need for additional upsizes and exchanges, and the high likelihood of failure. {1}. Catheter-directed mechanical thrombectomy (CDMT) has been reported as case reports for rectus hematoma drainage to allow faster resolution {2,3}.
Purpose/Objective: We aim to describe a novel hematoma evacuation technique using a catheter-directed mechanical thrombectomy system (CDMT).
Materials & Methods: We present two cases of retroperitoneal pelvic hematoma successfully treated with Penumbra Indigo CAT-12 mechanical thrombectomy catheter. Both patients presented with a symptomatic hematoma that failed to respond to image-guided percutaneous catheter drainage placement. The procedure time, evacuated volume, and outcomes were recorded. The pre-existing percutaneous drain was accessed with a 0.035 wire, and over this wire, an 11 French intravascular sheath was placed to secure access to the left pelvic hematoma. The contrast was instilled into the left pelvic chronic hematoma to evaluate the size and anatomic location. Chronic hematoma evacuation was performed using the thrombectomy CAT-12 catheter (Penumbra Indigo). A follow-up physical exam and CT imaging were obtained.
Results: A total of 300 cc and 600 cc of clot were removed from each collection, respectively. Follow-up imaging showed more than 50% hematoma resolution on axial and sagittal dimensions. Both patients received concomitant antibiotic therapy. The associated bloating and pelvic pain resolved soon thereafter. There were no minor or major complications associated with the procedure.
Conclusion: CDMT can be considered as an additional tool for the management of symptomatic pelvic hematomas, which are refractory to conventional catheter drainage therapy.
