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Management of severe forearm haematoma after trans-radial intervention

Management of severe forearm haematoma after trans-radial intervention. Fabienne Banchet on behalf of the Interventional Cardiology department, CHU Caen, France. Introduction. In the University hospital of Caen, 90% of diagnostic and intervention procedures are performed by TRA.

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Management of severe forearm haematoma after trans-radial intervention

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  1. Management of severe forearm haematoma after trans-radial intervention Fabienne Banchet on behalf of the Interventional Cardiology department, CHU Caen, France

  2. Introduction • In the University hospital of Caen, 90% of diagnostic and intervention procedures are performed by TRA. • TRA is associated with a drastic reduction of vascular access site complications related to: -Smaller guiding catheters usage - Sheath removal at the end of the procedure - Easy compression in high risk patients (obese patients, old patients, acute coronary syndromes

  3. The most frequent complications of trans-radial approach • Radial spasm - related to excessive catheter manipulation (during the lurning curve for example) • Vascular access site complications - bleeding, - haematoma,

  4. Case report Severe forearm haematoma • Male patient 76 years old • TRA using 5 F guiding catheter • ACS related to a tight stenosis of LAD • Successful direct stenting • Immediate sheath removal • 2 hrs after severe pain in forearm

  5. Solutions • Compression By compressive bandage applied to the forearm to create haemostasis. • Surgical evacuation? • Other? To resorb haematoma and avoid surgical evacuation

  6. Treatment by leeches • Leeches • Allowing forearm decompression • Avoiding surgery • pain relief

  7. Summary Leeches are available in this case and can avoid surgical intervention. But it’s very important to prevent this kind of complication by : • controls of puncture site after the procedure (nurses) • information of patient about complication signs, • Necessity to alert physicians as soon as bleeding, haematoma or forearm pain is observed • Application of strong compressive bandage immediatly

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