Hyperperfusion syndrome of the deltoid muscle after subclavian artery angioplasty and stenting.
OBJECTIVE
To report a case of hyperperfusion syndrome of the deltoid muscle after percutaneous transluminal angioplasty of a symptomatic high-grade subclavian artery stenosis.


METHODS
Immediately after balloon dilation of a left-sided subclavian artery stenosis, a 53-year-old man developed severe ipsilateral shoulder pain and swelling. Computed tomographic angiography revealed no extravasation or hematoma. Sonography showed massive edema and increased anteroposterior diameter of the left deltoid muscle (3.5 cm compared to 2.0 cm on the right). Hyperperfusion syndrome was suspected, and decompression by anterolateral fasciotomy was performed. Subsequently, both pain and swelling decreased. At day 3, the skin incision, which was temporarily covered with a synthetic skin substitute, was sutured; the wound healed uneventfully. Two weeks after surgery, both muscle strength and shoulder movements showed no restrictions.


CONCLUSIONS
Hyperperfusion syndrome after endovascular treatment of subclavian artery stenosis should be considered in the differential diagnosis of atypical muscle pain in the upper extremity. It may present as a compartment syndrome requiring surgical decompression.
Klocker
Josef
J
Department of Vascular Surgery, University of Innsbruck, Austria. josef.klocker@uibk.ac.at
Chemelli
Andreas
A
Bodner
Gerd
G
Gschwendtner
Andreas
A
Perkmann
Reinhold
R
Tauscher
Thomas
T
Jaschke
Werner
W
Fraedrich
Gustav
G
D000800:Angioplasty, Balloon / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply*; D012782:Shoulder; D015607:Stents / Q000009:adverse effects*; D013348:Subclavian Artery