A high-stakes, sometimes occult complication from a femoral puncture above the inguinal ligament; presents with flank/back pain, falling hemoglobin, and hemodynamic instability without an obviously large external hematoma, since the bleeding tracks internally. A high index of suspicion for any post-femoral-access patient with unexplained hypotension and back/flank pain is essential, with CT imaging used to confirm.
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