Cardiovascular Center, Sempo Tokyo Takanawa Hospital, 3-10-11 Takanawa, Minato-ku, Tokyo 108-8606, Japan.
Catheter Cardiovasc Interv. 2010 Feb 15;75(3):362-5. doi: 10.1002/ccd.22282.
Recently, transradial angiography and intervention have been performed with high success rates and low rates of vascular complications. The incidence of compartment syndrome after the transradial approach seems to be very low. However, bleeding in the arm can occur and may lead to the devastating complication of compartment syndrome of the forearm, which if not treated early, can evolve into a disability of the arm. In fact, most cases of such complications are caused by guidewire- or catheter-induced damage to small arterial branches that are considerably proximal to the puncture site. However, we encountered a case of compartment syndrome that was not caused by bleeding or hematoma formation and required urgent fasciotomy for its treatment. The forearm wounds were left open to allow the edema to resolve and closed after 1 week. The patient recovered and was discharged, with full movement of his forearm and hand. We suspect that an arterial spasm induced by the radial sheath or catheter resulted in ischemia of the forearm muscles. To our knowledge, this is the first reported case in which acute compartment syndrome of the forearm occurred after transradial intervention and was not due to bleeding or hematoma formation.
最近，经桡动脉血管造影和介入治疗的成功率很高，血管并发症的发生率很低。经桡动脉入路后发生筋膜间室综合征的发生率似乎非常低。然而，手臂可能会出血，并可能导致前臂筋膜间室综合征这一破坏性并发症，如果不早期治疗，可能会导致手臂残疾。事实上，大多数此类并发症是由导丝或导管引起的，损伤了距穿刺部位相当近的小动脉分支。然而，我们遇到了一例并非由出血或血肿形成引起的筋膜间室综合征，需要紧急切开减压治疗。前臂伤口保持开放，以允许水肿消退，1 周后再关闭。患者痊愈出院，前臂和手部活动完全恢复。我们怀疑桡动脉鞘或导管引起的动脉痉挛导致前臂肌肉缺血。据我们所知，这是首例报道的经桡动脉介入治疗后发生的非出血或血肿形成所致的急性前臂筋膜间室综合征。
