4 research outputs found
Rijedak sluÄaj intraneuralnog hematoma medijanog živca nakon stentiranja desne ilijaÄne arterije: prikaz sluÄaja
Aim: Brachial artery access is an alternative approach to endovascular interventions when access to the femoral, radial, or ulnar arteries is not feasible, but it carries higher risk of periprocedural complications than other approaches, including median nerve injury. Nerve injuries can occur by direct puncture or by compression, with hematoma being the most common cause. Sometimes the compartment syndrome can accompany the direct nerve injury, masking the signs of a nerve dysfunction. Case report: We present a patient with a false aneurysm of brachial artery, surrounding soft tissue hematoma with volar arm and forearm compartment syndrome and a simultaneous median nerve intraneural hematoma caused by a direct punction. The combination of injuries occurred after brachial artery access for endovascular treatment of bilateral iliac artery steno-occlusive disease. The patient was successfully treated by fasciotomy, arterial sutures, and nerve decompression via paraneuriotomy. Conclusions: Intraneural hematoma caused by direct puncture can be masked by concomitant compartment syndrome. Emphasis should be put on prevention, early recognition, and timely surgical treatment of intraneural hematomas, especially those accompanied by fascial compartment syndrome after endovascular interventions.Cilj: Pristup brahijalnoj arteriji alternativni je pristup endovaskularnim intervencijama kada pristup femoralnoj, radijalnoj ili ulnarnoj arteriji nije izvediv, ali nosi veÄi rizik od periproceduralnih komplikacija nego drugi pristupi, Å”to ukljuÄuje i ozljede medijanog živca. Ozljede živca mogu nastati izravnom punkcijom ili kompresijom, pri Äemu je najÄeÅ”Äi uzrok hematom. Ponekad sindrom miÅ”iÄnih odjeljaka može pratiti izravnu ozljedu živca, prikrivajuÄi znakove živÄane lezije. Prikaz sluÄaja: Predstavljamo bolesnicu s lažnom aneurizmom brahijalne arterije, okolnim hematomom mekih tkiva, sindromom volarnog miÅ”iÄnog odjeljka nadlaktice i podlaktice te s istodobnim intraneuralnim hematomom medijalnog živca koji je bio uzrokovan izravnom punkcijom. Ove udružene ozljede nastale su nakon punkcije brahijalne arterije u sklopu endovaskularnog lijeÄenja bilateralne stenookluzivne bolesti ilijaÄne arterije. Pacijentica je bila uspjeÅ”no lijeÄena fasciotomijom, izravnim Å”avom arterije i dekompresijom živca (paraneuriotomijom). ZakljuÄci: Intraneuralni hematom uzrokovan izravnom punkcijom može biti prikriven znakovima prateÄeg sindroma miÅ”iÄnih odjeljaka. Stoga treba staviti naglasak na prevenciju, rano prepoznavanje i pravodobno kirurÅ”ko lijeÄenje intraneuralnih hematoma, osobito onih popraÄenih sindromom miÅ”iÄnog odjeljka nakon endovaskularnih intervencija