Hand Hematoma After Cardiac Catheterization Via Distal Radial Artery

View the commentary to this article by Dr. Ian Gilchrist.

A 63-year-old female patient was referred to our clinic for coronary angiography due to non-ST elevation myocardial infarction. Coronary angiography was performed through the right distal radial artery using a 6 Fr, 11 cm-long sheath. A 90% stenosis was identified at the proximal left anterior descending artery and treated successfully with ad hoc angioplasty and stenting.

The sheath was removed at the end of the procedure, and manual hemostasis was applied. Twenty minutes after hemostasis completion, the patient reported hand pain and restricted motion of her fingers. The examination revealed a severe hematoma with swelling, extending from the anatomical snuffbox to the dorsal and palmar surfaces of the hand (Figures 1a and 1b). In order to avoid a possible compartment syndrome, intermittent blood pressure cuff inflations were applied, resulting in hematoma stabilization.

This is the first reported case of severe hand hematoma after cardiac catheterization through the distal radial artery, with the hematoma extending distally to the sheath insertion site. The distribution of the hematoma in our case is completely different compared to hematomas observed after traditional radial catheterization, which used to extend to the forearm. Therefore, the traditional EASY classification may not apply to hematomas after catheterization through the distal radial artery. 

Reprinted with permission from J Invasive Cardiol. 2018 Nov;30(11):428.

From the Second Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted June 18, 2018.

Address for correspondence: Eleftherios Kontopodis, MD, 2nd Department of Cardiology, Hellenic Red Cross Hospital, Athanasaki 1, GR 11526, Athens, Greece. Email: ekontopodis@gmail.com