Compartment Syndrome: A Rare and Frightening Complication of Transradial Catheterization

J INVASIVE CARDIOL 2018;30(10):E111-E112.

Key words: angiography, cardiac imaging, compartment syndrome, complications, radial intervention

A 42-year-old Asian man with triple-vessel coronary artery disease was denied coronary artery bypass graft and was submitted for percutaneous coronary intervention in our cath lab. We successfully stented the left anterior descending, but we didn’t manage to deliver the stent to the left circumflex, which had  stent restenosis proximally and subtotal occlusion thereafter. Two days later, the patient was admitted again. We attained left radial artery access this time with a 7 Fr sheath. We stented the obtuse marginal using a 7 Fr Extra-Backup catheter and a guide extension. Intravenous eptifibatide was given.

Within 2 hours of the procedure, the patient complained of forearm swelling and pain, which was not evaluated properly. Five hours post intervention, the patient suffered from a huge hematoma (EASY class V). The hand was pulseless, pale, and extremely painful. Blood pressure was  low and the patient was almost unconscious. The blood sample revealed 18% reduction of hematocrit and an extreme raise of CPK (3500 mg/dL). Compartment syndrome was diagnosed and digital angiography revealed compression of all arm and forearm vessels (especially the ulnar), but no more extravasation (Figure 1). The patient was treated with extended arm and forearm fasciotomies (Figure 2). The blood was drained and the hand was warm and pulsable again. The wounds were not sutured for continuing drainage and left open and sterile for healing by secondary intention (Figure 3). The patient received 5 units of red blood cells and 5 units of fresh frozen plasma. Within 40 days, the wounds were almost healed (Figure 4). Two and a half months later, the hand was fully healed and  functional (Figure 5). 

Compartment syndrome is the most severe complication of transradial approach and can be prevented by prompt treatment of forearm hematoma; otherwise, fasciotomies are urgent.

From the 1st Department of Cardiology, Athens Red Cross Hospital, Athens, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted May 14, 2018. 

Address for correspondence: Theodoros Zografos, MD, MSc, PhD, Consultant Cardiologist, 3rd Department of Cardiology, Hygeia Hospital Research Associate, Athens Red Cross Hospital, 8 Artemidos Street, 16672, Vari, Athens, Greece. Email: theodoroszografos@gmail.com