Usefulness of transpedal intervention for inferior epigastric artery bleeding following catheter ablation: a case report

BACKGROUND: Cardiovascular interventions may result in access-site complication, including inferior epigastric artery (IEA) bleeding. The IEA injury is generally treated through surgery and transcatheter embolization; however, additional complications should be avoided in the bailout procedure. Here, we present a case of catheter ablation complicated by IEA haemorrhage that we managed by transcatheter embolization using a transpedal intervention (TPI). CASE SUMMARY: A 58-year-old man underwent catheter ablation for symptomatic paroxysmal atrial fibrillation. Pulmonary vein isolation was performed uneventfully via catheterization of the right femoral artery and vein access. After the procedure, he complained of persistent abdominal pain and had a palpable mass in the lower right abdomen. Computed tomography angiography (CTA) revealed a haematoma in the right rectus abdominis with signs of active bleeding from a branch of the right IEA. We performed transcatheter arterial embolization through a TPI to stop bleeding and avoid further complication. No leakage of contrast media was detected after embolization using a microcoil and the abdominal pain improved. We did not observe any serious intraprocedural complications. DISCUSSION: Catheter ablation procedures may be complicated by access-site complications such as active bleeding. Arterial embolization is a feasible treatment approach to control the resulting haemorrhage. Embolization through the transpedal route (TPI) could be an effective bailout technique in the setting of emergent transcatheter arterial embolization to achieve haemostasis and avoid further complication.