Treatment of Acute Compartment Syndrome Is an Essential Part of Acute Limb Ischemia Management
Rteil A, Palmer J, Nypaver T, Shepard A, Weaver M, and Kabbani L. Treatment of Acute Compartment Syndrome Is an Essential Part of Acute Limb Ischemia Management. Journal of Vascular Surgery 2020; 72(1):e155.
Journal of Vascular Surgery
Objectives: There is a scarcity of studies looking at outcomes of patients with acute lower limb ischemia (ALI) requiring fasciotomy. We present the results of fasciotomies performed in the treatment of ALI at our institution.
Methods: We retrospectively analyzed data on a prospectively collected database of all ALI patients that presented to out tertiary referral hospital between May 2016 and November 2019. We included all patients who underwent fasciotomies for ALI. Prophylactic fasciotomies were defined as those done in the absence of clinical evidence compartment syndrome on presentation, and without visible bulging nor necrosis intraoperatively. Limb outcomes for each of the fasciotomy groups (therapeutic and prophylactic) were analyzed.
Results: During the study period 250 patients were treated for ALI at our institution involving 279 lower limbs. Sixty-three patients required 69 lower extremity fasciotomies. Rutherford ALI classification for the patients requiring fasciotomy was 32% class 2a, 55% class 2b, and 13% class 3. Early fasciotomy (during the primary operation) was performed on 81% of limbs; 13 patients (19%) had delayed fasciotomies. Fasciotomies were deemed therapeutic in 67% of limbs (16% of the total cohort) and prophylactic in 33% (Figure). Mean time until fasciotomy closure was 2.3 ± 2.9 days. Compared to ALI without fasciotomy, therapeutic fasciotomy was associated with a higher incidence of 30-day limb loss (40% vs 18%; P =.002) and prolonged length of hospital stay (18 days vs 10 days; P <.001). When comparing delayed fasciotomy for compartment syndrome to prophylactic fasciotomy at the time of the initial operation, there was a trend to increase 30 -ay limb loss (22% vs 5%; P =.2).
Conclusions: In the setting of ALI, 16% of lower limbs needed therapeutic fasciotomies due to acute compartment syndrome. As expected patients requiring therapeutic fasciotomy experience a significant higher rate of in limb loss and prolonged hospital length of stay. Although not statistically significant, delayed fasciotomy had a higher rate of limb loss when compared to prophylactic fasciotomy. Physicians who treat ALI need to be able to manage acute compartment syndrome.