Lower extremity compartment syndrome after off-pump aortocoronary bypass

Abstract

ower extremity compartment syndrome is a rare complication after on-pump coronary artery bypass grafting (CABG). It is associated with fasciotomy wound-related morbidity, occasional amputation, and universal occurrence of permanent foot drop. Compartment syndrome after off-pump CABG has not been reported so far. We report a case of lower limb compartment syndrome after off-pump CABG.

Acute Compartment Syndrome of the Lower Leg after Coronary Artery Bypass Grafting: A Silent but Dangerous Complication

“…4,10,11,16 In two cases of the total population 4,11 the placement of an IABP was most probably the cause of postoperative ACoS. In another case, ACoS was diagnosed 10 days after surgery, 6 days after arterial occlusion of the lower leg.…”

“…ACoS after coronary artery bypass grafting (CABG) is rare and only 15 cases have been reported in the English language literature (►Tables 1 and 2). [2][3][4][5][6][7][8][9][10][11][12] In Keywords ► coronary artery bypass grafts surgery ► CABG ► anesthesia ► cardiopulmonary bypass ► CPB ► IABP ► intensive care ► postoperative care Abstract Background Acute compartment syndrome (ACoS) is a serious, limb-threatening condition, but ACoS after coronary artery bypass grafting (CABG) is rare. ACoS is diagnosed with the help of typical symptoms, but due to the use of analgesics in a postoperative setting, these symptoms may vary.…”

Phlegmasia Cerulea Dolens after Coronary Artery Bypass Surgery: What Should We Know

“…For example, failure of venous return during extracorporeal circulation can induce PCD-type venous hypertension without thrombosis and lead to the abdominal compartment syndrome [3]. Similarly, several case reports of the lower limb compartment syndrome after CABG have been reported in the English-language literature [4,5]. Because its rarity makes it difficult to determine the precise mechanism, previous authors have proposed only two hypotheses for the compartment syndrome after CABG.…”

Lower limb compartment syndrome following coronary artery bypass surgery: a rare entity

“…In contrast to lower limb compartment syndrome due to a defi nite etiological factor (e.g., trauma or ischemia), its occurrence after cardiac surgery might be due to a combination of local and systemic factors that increase interstitial pressure within the compartment. 2,6 Local factors include local trauma to the vein donor limb, venous stasis, crural deep venous thrombosis secondary to ligation of the saphenous branches connecting to the perforating veins, and arterial ischemia. Arterial ischemia might be explained in part by the extrinsic compression of the crural muscle compartment by the elastic bandage.…”

“…A combination of CPB effects, diminished venous outfl ow, and postsurgical infl ammatory conditions predispose the donor limb to increased interstitial pressure. 2,6 Compartment syndrome can occur at pressures as low as 30 mmHg, without loss of arterial blood fl ow. Severe tenderness and pain on passive stretch are the initial signs of compartment syndrome.…”