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

Compartment Syndrome with Severe Neurovascular Complications after Trans-radial Approach of Percutaneous Coronary Intervention: A Case Report and Literature Review

陳佩儀(Pei-Yi Chen) ； 林紘毅(Hong-Yi Lin)

《台灣復健醫學雜誌》 50卷2期 (2022/12) Pp. 167-172

https://doi.org/10.6315/TJPMR.202212_50(2).0010

摘要

經皮冠狀動脈介入治療（Percutaneous coronary intervention, PCI）已作為急性冠心症的標準治療，其中橈動脈路徑（Trans-radial approach, TRA）是歐洲和亞洲國家做介入治療的主流。經橈動脈的冠狀動脈導管介入治療後可能會出現一些併發症，包括橈動脈痙攣、橈動脈阻塞、血腫和腔室症候群、動脈假性動脈瘤、動靜脈廔管和非阻塞性橈動脈損傷。一名66歲男性在進行經橈動脈的冠狀動脈導管介入治療後出現相關但少見的神經血管併發症，回顧其過去病史並佐以超音波與電學檢查之後，該患者診斷為與血腫誘發的筋膜腔室症候群相關的神經壓迫損傷的導管介入治療後併發症。在診間使用5%的葡萄糖溶液在正中神經、尺神經與橈神經周圍進行水分離術（hydrodissection），病人同時進行了藥物與物理治療，後續門診追蹤顯示臨床症狀有所改善。經橈動脈的冠狀動脈導管介入治療後的併發症發生率較低，然而早期發現、預防和適當的處裡可以降低併發症的發生率和嚴重度。本報告呈現此病例報告之臨床發現與相關療程以提供臨床醫師參考，係以期待臨床醫師對這些相對罕見的併發症的臨床症狀有所認識並轉介適當科別尋求協助。

關鍵字

經皮冠狀動脈介入治療（percutaneous coronary intervention） ； 經橈動脈transradial） ； 筋膜腔室症候群（compartment syndrome） ； 水分離術（hydrodissection）

並列摘要

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.

並列關鍵字

percutaneous coronary intervention ； transradial ； compartment syndrome ； hydrodissection

參考文獻

Ul Haq MA, Rashid M, Kwok CS, et al. Hand dysfunction after transradial artery catheterization for coronary procedures. World journal of cardiology 2017;9(7):609-19.

Cauley R, Wu WW, Doval A, et al. Identifying complications and optimizing consultations following transradial arterial access for cardiac procedures. Ann Vasc Surg 2019;56:87-96.

Araki T, Itaya H, Yamamoto M. Acute compartment syndrome of the forearm that occurred after transradial intervention and was not caused by bleeding or hematoma formation. Catheter Cardiovasc Interv 2010;75(3):362-5.

Jue J, Karam JA, Mejia A, et al. Compartment Syndrome of the Hand: A rare sequela of transradial cardiac catheterization. Texas Heart Institute Journal 2017;44(1):73-6.

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