Polyvinyl alcohol embolization of the inferior epigastric artery as treatment for abdominal wall hemorrhage from multiple sites complicating enoxaparin therapy

We report a case in which a life-threatening subcutaneous abdominal wall hemorrhage complicated enoxaparin therapy. Computed tomography revealed contrast extravasation into the hematoma at multiple levels. Selective left inferior epigastric arteriograms showed multiple bleeding sites, which were treated at multiple embolization sessions. After global embolization of inferior epigastric artery with polyvinyl alcohol particles, bleeding stopped and no ischemic complications developed for a 7 months follow-up. The wall irregularity and small pseudoaneurysms of the branches of the inferior epigastric artery, possibly occurring as a complication of subcutaneous enoxaparin injections, were thought to be responsible for the spontaneous hemorrhage at multiple sites. Global embolization of the inferior epigastric artery with PVA proved to be effective and safe.