Acute compartment syndrome of the forearm associated with transradial coronary intervention

2020 ◽  
Vol 45 (8) ◽  
pp. 852-856
Author(s):  
Young-Keun Lee ◽  
Se-Hwan Lee ◽  
Tae-Young Kwon
Keyword(s):  
Compartment Syndrome ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Distal Humerus ◽  
Level Of Evidence ◽  
Forearm Compartment Syndrome ◽  
The Mean ◽  
Transradial Intervention ◽  
Proximal Forearm ◽  
Mean Time

This study documents our experience with acute forearm compartment syndrome after percutaneous transradial coronary artery intervention and suggests several strategies to achieve good results. A retrospective review identified the medical records of four patients with acute forearm compartment syndrome after transradial intervention who were treated by urgent fasciotomy. The mean time from the onset of symptoms to operation was 5.7 hours. In three cases bleeding was from radial artery rupture at the puncture site, and one case was caused by brachial artery rupture at the level of the distal humerus and radial artery rupture at the level of proximal forearm. We obtained satisfactory results without any complications. If acute forearm compartment syndrome after transradial intervention is diagnosed, the site of bleeding should be identified preoperatively. Early surgical decompression produced satisfactory results even in elderly patients. Level of evidence: IV

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Borrego Rodriguez ◽  
C Palacios Echevarren ◽  
S Prieto Gonzalez ◽  
JC Echarte Morales ◽  
R Bergel Garcia ◽  
...  
Keyword(s):  
Phase Ii ◽  
Hospital Readmissions ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
The Mean ◽  
Acute Cardiovascular Event ◽  
Mean Time

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

Insidious Onset Compartment Syndrome of the Forearm in a Teenager: A Case Report and Review of the Literature

2021 ◽  
Vol 26 (03) ◽  
pp. 481-484
Author(s):  
Hidetoshi Iwata ◽  
Hideki Okamoto ◽  
Yohei Kawaguchi ◽  
Kojiro Endo ◽  
Yuji Joyo ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Single Case ◽  
Case Reports ◽  
Upper Extremities ◽  
Review Of The Literature ◽  
Right Hand ◽  
Insidious Onset ◽  
Forearm Compartment Syndrome ◽  
Cash Register ◽  
Proximal Forearm

Compartment syndrome affecting the upper extremities is a relatively underreported event compared with compartment syndrome affecting the lower extremities. Moreover, insidious onset forearm compartment syndrome has been rarely reported and is usually limited to single case reports. We report a compartment syndrome of the forearm in a teenager. She hit her right proximal forearm lightly on the cash register, but there was no pain. However, the next day, she had difficulty in moving her right hand. Although she underwent electrotherapy, her right forearm gradually became swollen, and she felt numbness in the ring and little fingers of her right hand. Six day after the onset, she came to our hospital and underwent fasciotomy. There was no aftereffect, and very good functional recovery was obtained. All clinicians need to keep the case of forearm compartment syndrome in a young individual with a diffuse course, such as in this case in mind.

scholarly journals Care time Delays in Acute Coronary Syndromes with Persistent St Elevation (stem) and the Delaying Factors: Prospective STUDY About 50 Cases in the Cardiology Department of Aristide le Dante Hospital.

2020 ◽  
Vol 2 (1) ◽  
pp. 01-03
Author(s):  
Momar Dioum
Keyword(s):  
Time Delay ◽  
Time Delays ◽  
Time Trial ◽  
Coronary Intervention ◽  
Self Medication ◽  
Coronary Syndrome ◽  
Cardiology Department ◽  
St Elevation ◽  
The Mean ◽  
Mean Time

The care of acute coronary syndrome with persistent ST-elevation (STEMI) is a time-trial race: ‘‘time is myocardium”. The treatment relies on myocardial reperfusion by percutaneous coronary intervention (PCI) or fibrinolysis as promptly as possible. The main objective of this work was to assess the care time delays and the delaying factors during STEMI. We conducted a prospective, descriptive and analytic study over a 6 months’ time period. Were included all the patients received for STEMI. We have studied the care time delays and the delaying factors. We have compiled 50 patients. The mean age was 58.4 years and the sex-ratio M/F 2.5. The chest pain was typical in 39 patients. The mean time elapsed between the beginning of the pain and the first medical contact was 12 h 16 min. Transport (76%) and self-medication (70%) were the significant delaying factors found (p = 0.0001). The mean time elapsed between the first medical contact and the electrocardiogram was 9 h 57 min. The main factors delaying the diagnosis were the unavailability of the electrocardiogram device and the absence of electrocardiogram prescription (p = 0.001). The mean time elapsed between the electrocardiogram and the admission in the cardiology department was 3 h 02 min. The transport was the principal factor lengthening that time delay (p = 0.0001). Among the patients admitted directly in cardiology department, the mean time delay to perform the ECG was 30 min. The mean time delay of fibrinolysis was 2 h 11 min. Streptokinase shortage was the most frequent delaying factor (p = 0.001). The mean time delay between the qualifying ECG and the PCI completion was 2 h 42 min. The unavailability of the medical team was the first factor lengthening that time delay (p = 0.0001). The care time delays were lengthened enough in our context. This testifies to the lack of a codified strategy for STEMI care. It is essential to develop pre-hospital emergency medicine and sensitize the population and healthcare professionals.

scholarly journals Compartment Syndrome of the Hand: A Rare Sequela of Transradial Cardiac Catheterization

2017 ◽  
Vol 44 (1) ◽  
pp. 73-76 ◽  
Author(s):  
Jennifer Jue ◽  
Joseph A. Karam ◽  
Alfonso Mejia ◽  
Adhir Shroff
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Compartment Syndrome ◽  
Radial Artery ◽  
Cardiac Catheterization ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Coronary Intervention ◽  
Postoperative Course ◽  
Right Hand ◽  
Percutaneous Coronary

A 64-year-old man who underwent percutaneous coronary intervention via right radial artery access reported right-hand pain and swelling 2 hours after the procedure. He had developed compartment syndrome of the hand, specifically with muscular compromise of the thenar compartment but with no involvement of the forearm. He underwent emergency right-hand compartment release and carpal tunnel release, followed by an uneventful postoperative course. In addition to our patient's case, we discuss compartment syndrome of the hand and related issues.

Vascularized ulnar periosteal pedicled flap for forearm nonunion in children

2021 ◽  
pp. 175319342110263
Author(s):  
Sergi Barrera-Ochoa ◽  
Rita Sapage ◽  
Sergi Alabau-Rodriguez ◽  
Tryno Muñoz-Perdomo ◽  
Jorge Knörr ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Pedicled Flap ◽  
Level Of Evidence ◽  
Radioulnar Synostosis ◽  
Versatile Technique ◽  
Preoperative Status ◽  
The Mean ◽  
Mean Time

We report our experience with the use of a vascularized ulnar periosteal pedicled flap to treat forearm nonunion in children. Seven children underwent surgical treatment of radial diaphysis nonunion with this technique. The mean duration of nonunion prior to the flap was 9 months. Significant postoperative improvements were observed in pain severity (mean visual analogue scale score of 0.6), Quick Disabilities of the Arm, Shoulder, and Hand (mean score of 7.1) and grip strength (89% higher than preoperative status). Union was achieved in all patients, with a mean time to union of 3 months. One patient developed distal radioulnar synostosis as a postoperative complication. A vascularized ulnar periosteal pedicled flap is a reliable and versatile technique for treating forearm nonunion in children, associated with both good outcomes and low donor morbidity. Level of evidence: IV

scholarly journals Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access

2021 ◽  
Vol 8 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Wei-Chieh Lee ◽  
Chieh-Ho Lee ◽  
Wen-Jung Chung ◽  
Shu-Kai Hsueh ◽  
...  
Keyword(s):  
Radial Artery ◽  
Chronic Total Occlusion ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Procedural Success

Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA).Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded.Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach.Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.

scholarly journals Transradial approach for acute stroke intervention: technical procedure and clinical outcomes

2019 ◽  
Vol 5 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Omaditya Khanna ◽  
Nikolaos Mouchtouris ◽  
Ahmad Sweid ◽  
Nohra Chalouhi ◽  
Ritam Ghosh ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Clinical Outcomes ◽  
Radial Artery ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Transradial Approach ◽  
Technical Procedure ◽  
The Mean ◽  
Vessel Dissection ◽  
Mean Time

Background and purposeRadial artery catheterisation is an alternate route of access that has recently started to gain more widespread use for neuroendovascular procedures, including acute stroke intervention. In this small case series, we present our institution’s outcomes in patients undergoing acute stroke interventions via transradial access.Materials and methodsWe present a retrospective study of 15 patients who underwent acute stroke intervention via radial artery access. We analyse these patients’ periprocedural and clinical outcomes after undergoing mechanical thrombectomy.ResultsA total of 15 consecutive patients were included in the study (9 males and 6 females), and all patients were able to successfully undergo mechanical thrombectomy via radial artery access. The mean time of arterial puncture to reperfusion was 50±28 min (range: 15–104). A TICI 2b/3 revascularisation was achieved in 13/15 patients (87%); a TICI 1 and TICI 2a outcome was achieved on the other two patients. One patient incurred an iatrogenic vessel dissection during the procedure. Eight of out 15 patients (53%) had favourable mRS (0–3) at the time of discharge from the hospital.ConclusionRadial artery catheterisation is technically feasible for performing acute stroke interventions with favourable time to revascularisation and good overall clinical outcomes.

Comparison between simple release and Z-plasty of retinaculum for de Quervain’s disease: a retrospective study

2019 ◽  
Vol 44 (4) ◽  
pp. 390-393
Author(s):  
Jin-young Kim ◽  
Jong-hun Baek ◽  
Jae-hoon Lee
Keyword(s):  
Daily Living ◽  
Analogue Scale ◽  
Statistical Difference ◽  
Level Of Evidence ◽  
De Quervain’S Disease ◽  
Surgical Methods ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Mean Time

We compared two surgical procedures for de Quervain’s disease that was not responsive to conservative treatment. Group A (simple release) consisted of 38 patients and group B (Z-plasty of the retinaculum) included 36 patients. The visual analogue scale score and the Disabilities of the Arm, Shoulder and Hand Score improved significantly after surgery; there were no statistical differences in outcome between the two groups. In group A, one patient required reoperation, two had subluxations of extensor tendons and two had temporary loss of sensation in the area of the radial nerve. In group B, two patients had temporary loss of sensation. The mean time to resolution of pain at the operative site was significantly shorter in group B. Both simple release and Z-plasty were effective surgical methods. Z-plasty allowed earlier return to activities of daily living but there was no statistical difference between the two groups in incidence of complication. Level of evidence: IV

P1761Distal transradial approach for primary percutaneous coronary intervention for patients with acute myocardial infarction: a multicentre study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Izumikawa ◽  
S Takeshita ◽  
T Yamada ◽  
Y Mizuguchi ◽  
N Taniguchi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Transradial Approach ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Distal Radial Artery

Abstract Background The distal transradial approach (dTRA) for coronary catheterisation is a newly introduced alternative to the conventional transradial approach. This technique is expected to decrease the incidence of haemorrhagic complications and improve patient comfort. However, limited data are available regarding the application of this technique in patients with acute myocardial infarction (AMI). This study investigated the feasibility and safety of the dTRA for primary percutaneous coronary intervention (PCI) in patients with AMI. Methods This study included patients with AMI who underwent primary PCI via the distal radial artery across 3 Japanese hospitals between January 2018 and January 2019. Patients' background, procedural characteristics, and clinical outcomes including the incidence of haemorrhagic complications were analysed. Results This study enrolled 95 consecutive patients with AMI, including 68 patients (71.6%) with ST-segment elevation myocardial infarction (STEMI), in whom distal radial artery puncture was attempted for primary PCI. The patients included 70 men (73.7%), and the mean age was 72.2±12.4 years. Among these patients, cannulation was successfully performed in 89 patients (93.7%). A 5-, 6-, or 7-French sheath (conventional or slender) was used in this study. Cannulation was performed using a forearm radial artery approach in patients in whom dTRA failed. PCI was successfully performed in all patients. The meantime to achieve haemostasis was 6.3±5.3 hours, and no major bleeding complications occurred. Based on The Early Discharge After Transradial Stenting of Coronary Arteries trial haematoma scale, grade I, II, and III subcutaneous haemorrhages were observed in 16 (16.8%), 4 (4.2%), and 1 patient (1.1%), respectively. No patient developed a haematoma > grade IV. In patients with STEMI, the mean door-to-balloon time was 39.4±31.9 min, and the mean puncture-to-balloon time was 19.7±14.2 min. Conclusions The distal radial approach is feasible and safefor primary PCI in selected patients with AMI.The application of the dTRA may serve as a less invasive strategy for the treatment of patients with AMI.

Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Suspended Position With the Patient in a Prone Position

2019 ◽  
Vol 40 (7) ◽  
pp. 811-817
Author(s):  
Chenyu Wang ◽  
Min Wook Kang ◽  
Hyong Nyun Kim
Keyword(s):  
Compartment Syndrome ◽  
Prone Position ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Arthroscopic Microfracture ◽  
The Mean

Background:The purpose of this study was to evaluate the clinical results and the safety of arthroscopic microfracture with the ankle suspended on a shoulder-holding traction frame for simultaneous anterior and posterior ankle arthroscopy in the prone position.Methods:Between May 2010 and January 2016, 31 patients with posterior osteochondral lesions of the talus (OLTs) were treated with arthroscopic microfracture in a suspended position with the patient prone. Ankle distraction was achieved by suspending the affected ankle on a shoulder-holding traction frame. The 100 mm visual analog scale (VAS) and the Foot Function Index (FFI) were checked preoperatively and at final follow-up. Postoperative complications related to the suspended position were analyzed. Lower leg intramuscular compartment pressure was checked after the surgery to determine if there was any risk of compartment syndrome.Results:The mean 100-mm VAS score, and FFI improved from 62.8 ±11.3 and 48.5 ± 12.1, respectively, preoperatively to 15.8 ± 10.4 and 16.4 ± 9.2, respectively, at final follow-up ( P = .025, and P = .005, respectively). The mean anterior, lateral, superficial posterior, and deep posterior compartment pressures were 7.3 ± 1.5, 8.1 ± 1.1, 5.6 ± 1.9, and 9.2 ± 2.4 mmHg, respectively. No compartment syndrome occurred.Conclusion:Arthroscopic treatment of OLT in a prone position with the ankle suspended on a shoulder-holding traction frame allowed the use of simultaneous anterior and posterior portals for viewing and instrumentation without major operative complications, such as compartment syndrome.Level of Evidence:Level IV, retrospective case series.

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