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Rehabilitation Practice and Science

Translated Title

經橈動脈的冠狀動脈導管介入合併腔室症候群及嚴重神經血管併發症：病例報告及文獻回顧

Abstract

The gold standard for the acute coronary syndrome is percutaneous coronary intervention. Access site practice has shifted from transfemoral to transradialaccess (TRA), with the latter being more popular in Europe and Asia due to higher success rates, fewer site-related vascular complications, mortality, and shorter hospital stay. Significant complications following TRA of percutaneous coronary intervention have been reported, including spasm, occlusion, perforation, pseudoaneurysm formation, arteriovenous fistula, and rarely, compartment syndrome and complex regional pain syndrome (CRPS). Here, we report the case of a 66-y-old male who had persistent right-hand painful swelling, clawed hand, and sensory disturbance for 2 months following TRA percutaneous coronary intervention. Around 4 h after the procedure, there was pain, heat, and swelling over the right forearm and hand, according to the medical record and recall. Bandage compression was prescribed at that time, but the sensation of pain, heat, and swelling persisted after discharge. Due to persisted symptoms accompanied with hand dysfunction after 2 months of PCI, he came to our OPD for help. The nerve conduction study showed no wave record over the right ulnar nerve, median nerve, and radial nerve. Musculoskeletal ultrasound discovered hyperechoic fibrosis change over right forearm muscle especially flexor digitorum profundus and flexor digitorums superficialis muscle. Post catheter complication with hematoma-induced compartment syndrome related to nerve compression injury and CRPS was diagnosed. After echo-guided hydrodissection around the median nerve and ulnar nerve with 5% glucose solution, medicationand physical therapy, the symptoms and weakness were improved after one month follow-up. Major access complications following TRA are less frequent; however, early detection, prevention awareness, and appropriate management were critical, potentially lowering the complication rate and severity of complications.

Language

Traditional Chinese

First Page

167

Last Page

172

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