Compartment syndrome of the arm caused by transcatheter angiography or angioplasty

Abstract

Compartment syndrome of the arm is a rare condition because of the large capacity of the arm compartment. Although several cases of compartment syndrome of the forearm associated with vascular access procedures have been reported, the literature contains few detailed reports of compartment syndrome of the arm caused by transcather angiography or angioplasty. This article presents 4 cases of compartment syndrome of the anterior arm caused by transcatheter angiography or angioplasty; all patients required surgical treatment and anticoagulation therapy. Following urgent fasciotomy and hemostasis, 1 patient experienced recurrent bleeding and another exhibited delayed complex regional pain syndrome of the forearm. The remaining 2 cases had good outcomes. Because all patients had been prescribed various oral anticoagulants, their compartment syndrome was considered a complication of thrombolytic therapy. In addition, because all patients had a history of multiple arterial diseases, atherosclerosis was considered to be severely advanced and the vessels to be easily damaged. Due to the authors' experiences with these 4 cases, they recommend that surgery be performed under general rather than local anesthesia and that the bleeding site be sutured or ligated. Compression of the bleeding point alone could allow heavy bleeding or recurrence of bleeding to occur because of the influence of anticoagulation therapy. Continuous bleeding of the arm may expand into the volar compartment of the forearm, leading to a condition similar to chronic compartment syndrome. Effective hemostasis, in addition to early decompressive fasciotomy, is essential in compartment syndrome caused by the catheter procedure.