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P 11
QUELLE EST LA VOIE D’ABORD À PRIVILÉGIER CHEZ LE SUJET ÂGÉ DE PLUS
DE 75 ANS
Présentateur : Nizar BEN MANSOUR, Tunis –TUN
Auteurs : N.BEN MANSOUR - N.HAJLAOUI
Co-Auteurs : L .SAEED - T .FILALI - M .GHOMMIDH - A .HAGGUI - I .SAAIDI - D .LAHIDHEB W.
FEHRI - H. HAOUALA
Background: Transradial approach for coronary angiography and intervention is actually widely used. The
nearly absence of local vascular complication is one of its advantages. Acute compartment syndrome is a rare
but dramatic complication of transradial approach. Literature on this complication is scarce .We reported a new
case of acute compartment syndrome which happens 24 h after transradial rescue angioplasty.
Objective: Through a case report and a review of literature we propose to study physiopathology, risk factors,
prognosis and available treatments for acute compartment syndrome following radial coronary intervention.
Case report: A 76 year old man was admitted in our cardiac care unit for inferior ST elevation myocardial infarction.
A thrombolytic therapy with streptokinase was indicated. 30min after the beginning of thrombolysis the
patient presented signs of shock with evidence of right ventricular extension. The patient underwent a rescue
angioplasty. A 6 French radial approach was used (as we do with the majority for our patients who underwent
coronary angiography or angioplasty). A proximal radial stenosis was easily crossed by the guide wire and after
that by the catheters. Coronary angiography showed a proximal occlusion of a dominant circumflex artery.
Angioplasty with bare metal stent implantation was performed with good result. Manual compression was performed
after sheath removal.
6 hours after the procedure, local swelling and hematoma at puncture site developed abruptly, Patient complained
of right forearm pain and numbness. Radial artery bleeding with acute compartment syndrome of right
forearm was diagnosed so he received fasciotomy.
Post operative evolution was not favourable with persistent signs of shock necessitating inotropic drugs and
artificial ventilation for several days.
Conclusion: Acute compartment syndrome after transradial cardiac catheterization is rare but with dramatic
consequences. The prompt diagnosis and treatment are important. Risk factors of this complication like elderly
patients, weak weight and excessive anticoagulation have to be known.
62 Congrès Francophone de Cardiologie Interventionnelle 2011