Compartment syndrome as a complication of transradial access

Compartment syndrome (CS) is an orthopaedic emergency that can result in vascular and neurologic compromise and necrosis due to increased pressure in an anatomic compartment, commonly the lower leg or forearm. The purpose of this case series study was to demonstrate that CS is a rare but serious complication for which physicians should have a low threshold for suspicion after transradial access procedures. We present a series of five patients who underwent fasciotomy for upper extremity CS in the setting of recent transradial access at a large, busy, tertiary academic center from 1/2015-12/31/2022. Cases were identified retrospectively from departmental case logs and data were collected by manual chart review. Patient demographics and comorbidities, as well as details of transradial access procedures and anticoagulation use were recorded. The outcome variables collected included time from access removal to hand surgery consult, symptoms present at the time of the consult, procedural details, and postoperative outcomes. Of the five cases presented, three underwent transradial access for percutaneous coronary intervention (PCI) and two for invasive blood pressure monitoring. Four of the five patients received systemic anticoagulation prior to or during transradial access, and the fifth received anticoagulation after the procedure. All five patients presented with large forearm hematomas at the time of initial consult, and three of the five were found at the time of fasciotomies to have radial artery lacerations. Two patients had subsequent surgeries after the primary fasciotomy, and one patient had residual neurologic symptoms. The results point to several key takeaways regarding CS in the setting of transradial access, including association with receipt of systemic anticoagulation, presence of forearm hematomas as potential markers for radial artery laceration, and multiple arterial lacerations as potential risk factors for worse post-fasciotomy outcomes. To our knowledge, this is the largest case series describing this specific, devasting complication of transradial access. Hand surgeons should be aware of this rare etiology of compartment syndrome so that they may more quickly recognize and respond to this potential complication.