Acute compartment syndrome occurring in forearm with relatively small amount of hematoma following transradial coronary
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CASE REPORT
Acute compartment syndrome occurring in forearm with relatively small amount of hematoma following transradial coronary intervention Atsuhiko Sugimoto1 • Jotaro Iwamoto1 • Naoko Tsumuraya1 • Masakazu Nagaoka1 Yuji Ikari2
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Received: 13 January 2015 / Accepted: 5 April 2015 Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract A 59-year-old female with angina pectoris successfully underwent percutaneous coronary intervention via the right radial artery. She complained of right forearm pain and numbness 4.5 h after the procedure. Though the swelling in her right arm seemed relatively mild, pressure measurement showed significant increase of internal forearm pressure. She developed acute compartment syndrome in the right forearm, and fasciotomy was performed immediately. The weight of subcutaneous hematoma in her right arm was approximately 100 g. Symptoms of paralysis and the impairment of perception remained for some time, but had completely recovered 4 months post-surgery. Keywords Complications of interventional procedures Transradial intervention (TRI) Hematoma
Introduction Percutaneous coronary intervention (PCI) via the transradial approach (transradial intervention, TRI) is associated with lower risk of major vascular complications or major bleeding at the access site compared with the transfemoral approach [1, 2]. While TRI has been generally applied, there are associated complications however. It is reported that the incidence of acute compartment syndrome in forearm is very low [3, 4]; nevertheless, if surgery is not & Atsuhiko Sugimoto [email protected] 1
Department of Cardiology, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, Japan
2
Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, Japan
performed promptly, it may lead to lingering dysfunction and ultimately amputation may be required. Furthermore, if it occurs in the dominant hand, the result will be critical and may seriously affect the patients throughout their lifetime. The cause of acute compartment syndrome of the forearm is known to be hematoma following perforation of the artery [4]. We herein report a case of acute compartment syndrome with relatively small amount of hematoma after TRI, which fully recovered following fasciotomy.
Case report A 59-year-old female presented with chest pain on exertion in April 2013 and consulted a physician in a local hospital. She had a history of high blood pressure and dyslipidemia, with medication prescribed at the hospital. The hospital physician diagnosed her with angina pectoris and referred her to our hospital. Patient body surface area (BSA) was 1.39 mm2 (body height 155 cm, body weight 44 kg). Heart sounds were normal without murmurs, rubs, or gallops. The electrocardiogram showed no ST-T segment changes during the asymptomatic phase. Chest X-ray showed no significant abnormality. The echocardiogram demonstrated normal left ventricular contraction withou
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