Which of the following is a symptom of a retroperitoneal bleed after arterial access?

• A. Unexplained hypotension
• B. Localized hand swelling
• C. Chest pain
• D. Headache

Answer: (A)

A retroperitoneal bleed after arterial access most clearly presents with unexplained hypotension due to hidden bleeding accumulating in the retroperitoneal space. Blood can escape from the arterial puncture site into the retroperitoneum and track away from the groin, so there may be little or no external hematoma. The patient can become pale, tachycardic, and hypotensive even if the groin looks clean, and back or flank pain may be present as the bleed enlarges.

Localized hand swelling doesn’t fit this scenario because it points to a local issue near the access site or peripheral venous/soft tissue problems, not a bleed into the retroperitoneum. Chest pain suggests a cardiac or thoracic process, not a retroperitoneal bleed, and headache isn’t a feature of this complication. Recognizing unexplained low blood pressure in the setting of recent arterial access is the key sign that raises concern for a retroperitoneal hemorrhage, prompting rapid assessment and management.