Haematoma and Compartment Syndrome Following Arterial Access

Background: Compartment syndrome of the upper limb is a rare but potentially devastating complication following endovascular access.Its management is further complicated in cardiac patients, among whom anaesthetic and surgical management carry a relatively high risk of morbidity and mortality.We present a suggested treatment protocol for this condition.Methods: In this retrospective study, conducted in our unit, a 0.02% risk of compartment syndrome was observed among cardiology patients following arterial access.Patient notes were reviewed and multidisciplinary discussions were organised to better inform assessment and treatment.Results: Risk factors relating to the patient, access, medical characteristics and subsequent management were identified using our cohort and a literature review.Treatable factors were also identified, including incorrect distal TR Band placement (resulting in distal haematoma) and proximal extravascular escape of the catheter (resulting in variable proximal haematoma).We developed a protocol for managing a developing haematoma to prevent progression to compartment syndrome.For distal haematoma, a tourniquet is inflated to suprasystolic pressure proximally, and the TR Band is resited.For proximal haematoma, during a 15-minute tourniquet inflation, a pressure dressing is applied to the suspected bleeding site.In both situations, prompt surgical assessment is required if ongoing swelling occurs.Conclusions: In this cohort, we demonstrated that good outcomes can be achieved despite the potential for severe complications from compartment syndrome.We suggest the use of our protocol to inform the management of this condition.