062 - Hemoscrotum Development Following Elective Femoral Endarterectomy and Iliac Stenting
Saum Rahimi, MD – Division Chief, Vascular Surgery, Rutgers Robert Wood Johnson University Hospital; Huong Truong, MD – Faculty, Vascular Surgery, Rutgers Robert Wood Johnson University Hospital
Purpose: Scrotal hematoma is a rare complication following often following endovascular interventions. We report a patient who developed large scrotal hematoma after an elective procedure, which then required blood transfusions, an additional operative groin exploration as well as drainage of the scrotum with hematoma evacuation by a consulting surgical team.
Material and Methods: A 60-year-old male smoker with ischemic cardiomyopathy, paroxysmal atrial flutter, and a CABG 5 months prior, was followed in the office for bilateral lower extremity rest pain. Preoperative ankle-brachial indices were 0.72 and 0.49, respectively, for which the patient underwent a left common femoral endarterectomy with bilateral ‘kissing’ common iliac stents. The procedure was complicated by the loss of pulses in the right foot warranting an angiogram via antegrade right femoral access that demonstrated patent single vessel runoff. Four hours later in the recovery room, he was noted to forcefully cough and sit up, immediately developing a large hemoscrotum. Due to the concern for active bleeding, the patient was taken back to the operating room for an exploration of the right femoral artery with completion angiography. Upon investigation, there was no active extravasation or hematoma in the right groin. Urology was then called intra-operatively for evaluation of the scrotum and performed a scrotal hematoma evacuation with bilateral orchiopexy. Postoperatively, the patient was managed conservatively with rest, pain control, and a supportive scrotal sling.
Results: The patient was discharged on postoperative day 3 with outpatient follow-up with both vascular surgery and urology, with the planned delayed removal of the Penrose drain in the office. He has since been seen in the office and is doing well, with no long-term testicular complications.
Conclusions: Complications of endovascular procedures are well-known, including hematomas, arterial dissections, pseudoaneurysms, thrombosis, and retroperitoneal bleeding, however, the development of hemoscrotum is rare. Though management of scrotal hematoma is primarily conservative, serious presentations may require blood transfusions for hemodynamic instability or major bleeding, with surgical intervention reserved for cases with concern for active bleeding or compromised blood supply to testes. Fortunately, patients often completely recover if detected early and the source of bleeding is controlled.