First Reported Case of Skin Necrosis Due to Prolonged Mechanical Compression After Transradial Catheterization

Key words: cardiac imaging, complication, radial access

A 65-year-old patient was catheterized via right radial artery twice in 5 days due to unstable angina, in order to have staged revascularization. He had mechanical compression with dedicated hemostasis device after 6 Fr sheath removal. As he was under triple-antithrombotic therapy (oral anticoagulation, clopidogrel, and aspirin), he needed prolonged compression in order to achieve adequate hemostasis, especially after the second procedure. Five days after discharge, the patient returned, complaining about his forearm and a 3 x 3 cm necrotic area at the point of puncture, which matched the shape of the silicone compressor. Around the necrotic skin, there was erythema, slight edema, itchiness, and hypesthesia. He was referred to the Vascular Surgery and Plastic Surgery departments to assess the situation. Extra pressure applied repeatedly on the same area seemed to be the cause of the skin disorder. They decided to treat him surgically by removing necrotic tissue and covering the area with a regional flap. Follow-up 6 months later revealed complete healing of the treated area with patency of the underlying radial artery.

Prolonged mechanical compression due to inadequate hemostasis may lead to skin injury or even necrosis that may need surgical treatment. Patients under triple therapy (who need extra hemostatic pressure on the access site) and patients with recurring procedures may be at risk for this severe complication. This is the first case reported.

From ¹the Athens Red Cross Hospital, 1st Cardiological Department, Athens, Greece; and ²“Genimatas” General Hospital Athens, Plastic Surgery and Burning Disorders Department, 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.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 15, 2019.

Address for correspondence: Ioannis Tsiafoutis, MD, 1st Cardiology Department, Athens Red Cross Hospital, 1 Athanasaki St 11521, Athens, Greece. Email: tsiafoutisg@yahoo.com