Disclosures: Hillary Ramroop, DO: No financial relationships or conflicts of interest

Case Description: 84-year-old- male with peripheral arterial disease, two left femoral stents, atrial fibrillation on rivaroxaban presented with severe left lower extremity pain. He denied trauma to the area. CT scan of the left lower extremity revealed a left soleus intramuscular hematoma with diffuse soft tissue edema of the left calf. He was diagnosed with acute compartment syndrome and underwent emergent fasciotomy and had two wound vacuums placed. He was made weight bearing as tolerated and admitted to the acute rehabilitation unit.

Setting: Tertiary teaching hospital

Patient: 84-year-old- male presented with left lower extremity pain found to have compartment syndrome Assessment/

Results: An arterial duplex study revealed non-occlusive material near the femoral stent with limited blood flow, as well as extensive calcification of the anterior and posterior tibial arteries, indicating severe lower extremity peripheral artery disease. Patient’s pain improved following fasciotomy and he achieved a contact guard level of ambulation upon discharge.

Discussion: Acute compartment syndrome commonly occurs after trauma, when fascial compartment pressures exceed perfusion pressure, resulting in tissue ischemia and ultimately necrosis. Emergent fasciotomy is required to release the involved muscular components. Rivaroxaban is used to prevent thromboembolism, with a known risk of bleeding. Few studies have been published regarding atraumatic spontaneous bleeding resulting in compartment syndrome. Severe arterial disease can contribute to the formation of collateral circulation and lead to muscle ischemia and tissue compromise. Initial rehabilitation goals include proper wound care to prevent infection, minimizing post-operative swelling, and passive range of motion exercises.

Conclusion: Acute compartment syndrome is a limb and life -threatening surgical emergency. It is important to note, that even though traumatic injuries are the most common cause, spontaneous bleeding into the leg can alter fascial compartment pressures. This is combination with severe peripheral arterial disease can lead to compartment syndrome.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/compartment-syndrome-in-a-patient-on-rivaroxaban-with-severe-peripheral-arterial-disease-a-case-report/