Isolated dorsal interosseous compartment syndrome of the hand following distal transradial access for percutaneous coronary intervention: a case report

Introduction: Distal transradial access (dTRA) preserves the forearm radial artery and may be useful in patients who require future dialysis access. However, dorsal hand hematoma after dTRA may lead to compartment syndrome. We report an 89-year-old man receiving hemodialysis and dual antiplatelet therapy who developed isolated dorsal interosseous compartment syndrome after percutaneous coronary intervention via right dTRA. Approximately 18 hours after the procedure, he presented with severe dorsal hand pain, tense swelling, and markedly restricted active finger motion, despite a soft, well-perfused palm. Dorsal interosseous compartment pressures ranged from 24 to 44 mmHg, with a minimum differential pressure of 30 mmHg. Emergency fasciotomy was performed approximately 21 hours after PCI, and all four dorsal interosseous compartments were decompressed through two longitudinal incisions; a localized hematoma was evacuated. His pain resolved immediately, and full, painless finger motion was restored by 2 months after surgery. Progressive dorsal swelling and disproportionate pain after dTRA should prompt urgent assessment, as preserved ulnar flow and palmar perfusion do not exclude dorsal interosseous compartment syndrome.