PDF(Pubmed)
Abstract：
BACKGROUND: Acute compartment syndrome following a transradial coronary approach is rare. However, as the incidence of coronary arterial disease increases due to lifestyle factors and multiple comorbidities, transradial coronary angiography has become more common for diagnostic and therapeutic purposes in cardiovascular centers. Despite its rarity, we encountered two cases of acute compartment syndrome within a 1-week interval in the cardiology unit of a tertiary hospital.
METHODS: The first case involved a 75-year-old woman diagnosed with non-ST elevation myocardial infarction (NSTEMI). A coronary angiogram was performed via an uncomplicated right radial artery puncture. Following the procedure, the patient experienced significant swelling in the right forearm. An emergency fasciotomy release of the right forearm was conducted, revealing a gushing hematoma upon entering the flexor compartment. Fortunately, the wound healed well two months postoperatively with no functional deficits. In the second case, an 80-year-old man presented with severe angina pectoris upon exertion and was diagnosed with NSTEMI. The following day, he developed compartment syndrome in the left forearm, necessitating an emergency fasciotomy. Intraoperative examination revealed muscle bulging within the forearm compartments accompanied by extensive hematoma. Postoperatively, a deranged coagulation profile caused oozing from the wound. However, since there was no arterial bleeding, a compression dressing was applied. This led to a gradual drop in hemoglobin levels and worsened his heart condition. Despite resuscitative efforts and attempts to correct the coagulopathy, the patient experienced cardiorespiratory arrest and succumbed to ischemic heart disease in failure.
CONCLUSIONS: Clinicians must remain vigilant in identifying this potentially limb-threatening condition. Patients with pre-existing anticoagulant therapy and underlying atherosclerotic disease are at a higher risk of bleeding complications. Implementing effective hemostasis techniques and promptly managing swelling can help prevent the occurrence of compartment syndrome. Timely assessment and maintaining a high level of clinical suspicion are paramount. If necessary, early consideration of decompressive fasciotomy is essential to avert catastrophic outcomes.
METHODS: The first case involved a 75-year-old woman diagnosed with non-ST elevation myocardial infarction (NSTEMI). A coronary angiogram was performed via an uncomplicated right radial artery puncture. Following the procedure, the patient experienced significant swelling in the right forearm. An emergency fasciotomy release of the right forearm was conducted, revealing a gushing hematoma upon entering the flexor compartment. Fortunately, the wound healed well two months postoperatively with no functional deficits. In the second case, an 80-year-old man presented with severe angina pectoris upon exertion and was diagnosed with NSTEMI. The following day, he developed compartment syndrome in the left forearm, necessitating an emergency fasciotomy. Intraoperative examination revealed muscle bulging within the forearm compartments accompanied by extensive hematoma. Postoperatively, a deranged coagulation profile caused oozing from the wound. However, since there was no arterial bleeding, a compression dressing was applied. This led to a gradual drop in hemoglobin levels and worsened his heart condition. Despite resuscitative efforts and attempts to correct the coagulopathy, the patient experienced cardiorespiratory arrest and succumbed to ischemic heart disease in failure.
CONCLUSIONS: Clinicians must remain vigilant in identifying this potentially limb-threatening condition. Patients with pre-existing anticoagulant therapy and underlying atherosclerotic disease are at a higher risk of bleeding complications. Implementing effective hemostasis techniques and promptly managing swelling can help prevent the occurrence of compartment syndrome. Timely assessment and maintaining a high level of clinical suspicion are paramount. If necessary, early consideration of decompressive fasciotomy is essential to avert catastrophic outcomes.
摘要：
背景：经桡动脉冠状动脉入路后的急性室综合征很少见。然而,由于生活方式因素和多种合并症，冠状动脉疾病的发病率增加，经桡动脉冠状动脉造影在心血管中心的诊断和治疗目的越来越普遍.尽管它很罕见,我们在三级医院的心内科1周内遇到2例急性骨筋膜室综合征.
方法：首例病例涉及一名诊断为非ST段抬高型心肌梗死（NSTEMI）的75岁女性。通过简单的右桡动脉穿刺进行冠状动脉造影。按照程序，患者出现了严重的右前臂肿胀。进行了右前臂的紧急筋膜切开术，进入屈肌室后出现涌出的血肿。幸运的是,术后两个月伤口愈合良好，无功能缺陷。在第二种情况下，一名80岁男性在劳累时出现严重心绞痛,并被诊断为NSTEMI.第二天,他在左前臂出现了骨筋膜室综合征,需要紧急筋膜切开术。术中检查显示前臂隔内肌肉膨出，并伴有广泛的血肿。术后,凝血功能紊乱导致伤口渗出。然而,因为没有动脉出血,应用压缩敷料。这导致血红蛋白水平逐渐下降，并使他的心脏状况恶化。尽管进行了复苏努力并尝试纠正凝血病，患者经历了心肺骤停，并死于缺血性心脏病衰竭。
结论：临床医生必须保持警惕，识别这种潜在的威胁肢体的情况。预先存在抗凝治疗和潜在动脉粥样硬化疾病的患者出血并发症的风险较高。实施有效的止血技术和及时处理肿胀有助于预防骨筋膜室综合征的发生。及时评估和保持高水平的临床怀疑至关重要。如有必要,早期考虑筋膜减压切开术对于避免灾难性结局至关重要.
方法：首例病例涉及一名诊断为非ST段抬高型心肌梗死（NSTEMI）的75岁女性。通过简单的右桡动脉穿刺进行冠状动脉造影。按照程序，患者出现了严重的右前臂肿胀。进行了右前臂的紧急筋膜切开术，进入屈肌室后出现涌出的血肿。幸运的是,术后两个月伤口愈合良好，无功能缺陷。在第二种情况下，一名80岁男性在劳累时出现严重心绞痛,并被诊断为NSTEMI.第二天,他在左前臂出现了骨筋膜室综合征,需要紧急筋膜切开术。术中检查显示前臂隔内肌肉膨出，并伴有广泛的血肿。术后,凝血功能紊乱导致伤口渗出。然而,因为没有动脉出血,应用压缩敷料。这导致血红蛋白水平逐渐下降，并使他的心脏状况恶化。尽管进行了复苏努力并尝试纠正凝血病，患者经历了心肺骤停，并死于缺血性心脏病衰竭。
结论：临床医生必须保持警惕，识别这种潜在的威胁肢体的情况。预先存在抗凝治疗和潜在动脉粥样硬化疾病的患者出血并发症的风险较高。实施有效的止血技术和及时处理肿胀有助于预防骨筋膜室综合征的发生。及时评估和保持高水平的临床怀疑至关重要。如有必要,早期考虑筋膜减压切开术对于避免灾难性结局至关重要.
