What complication can arise from manually pulling the sheath during a procedure?

Manually pulling the sheath during a procedure can lead to multiple complications, making the selection of "all of the above" a comprehensive choice that captures the potential risks involved.

Retroperitoneal bleeding can occur as a result of vascular injury when the sheath is pulled too aggressively. This bleeding typically takes place in the space behind the peritoneum and can lead to significant and sometimes life-threatening complications if not promptly identified and managed.

Additionally, a pseudoaneurysm may develop if the integrity of the blood vessel is compromised during sheath manipulation. This occurs when blood escapes the vessel lumen but remains confined by surrounding tissues, creating a false aneurysm.

Numbness and weakness in the affected limb can be the result of nerve injury or compromised blood flow due to sheath movement. This complication highlights the importance of careful handling of the sheath to avoid any potential harm to adjacent structures.

By recognizing that manually pulling the sheath carries multiple risks, it is clear why "all of the above" is the correct answer, as each of these complications reflects a serious concern for patient safety during cardiovascular procedures.