Incidence of Compartment Syndrome of the Arm in a Large Series of Transradial Approach for Coronary Procedures

Abstract

Despite the fact that transradial approach is widely used, literature on this devastating complication after transradial approach is scarce. Pubmed review from 1992 to 2007 includes only 5 isolated reports. In one small series with 250 patients, an incidence of 0.4% is suggested. We conducted a retrospective review of the transradial cases in Laval Hospital from 1994 to September 2007 (51,296 procedures) to know the incidence of compartment syndrome of the arm (CSA) and compare it with the literature. In our institution CSA occurred in 2 of the 51,296 transradial procedures (0.004%). Both of them were in female patients with low BSA (1.7 and 1.5 m(2)) who received either an excess of unfractioned heparin during the procedure or uncorrected low-molecular-weight heparin after the procedure. Both of them underwent fasciotomy of the forearm. Recovery was complete in one patient. The other patient required skin graft and developed a partial Volkmann contracture at follow-up. This low incidence is due to a high index of suspicion when swelling or pain in the arm used for the procedure is noted and to the immediate application of a specific protocol. This protocol initiated by the nursing personnel consists of inflation of a tensiometer cuff at the point of pain or swelling. Cuff is inflated during at least 15 minutes up to 10-15 mmHg below the systolic pressure to allow distal pulsatile flow to the hand or forearm (monitored with oxymetry/plethismography) so the bleeding stops and diffuses to decrease the pressure within the forearm. Usually, two periods of 15 min of inflation are required to control bleeding. Incidence of CSA is very low at our institution. A high suspicion with any complaint of pain and swelling in the arm and a proper management of anticoagulation especially in the postprocedure period with great emphasis in patients with low BSA or low creatinine clearance are the key points. Implantation of an immediate specific nursing protocol is required.