Disclosures: Yi Zhou, MD: No financial relationships or conflicts of interest

Case Diagnosis: 34-year-old African American male smoker with history of hypertension, chronic kidney disease, and recent MDMA use developed lower extremity compartment syndrome following aortic dissection repair.

Case Description or Program Description: Patient presented with severe chest pain. He was hypertensive and tachycardic. Physical exam was notable for holosystolic murmur, palpable pulses, intact sensation, and strength was 5/5 in all four extremities. CTA revealed Type A aortic dissection extending throughout the aortic root to the iliacs and common femoral arteries. He underwent emergent ascending aortic aneurysm repair.

Two days post-procedure, the patient developed new RLE pain, calf swelling and decreased function. On exam his RLE had detectable pedal pulses but was tense and tender. He had pain on passive ROM along with decreased strength on dorsiflexion and plantarflexion. He was taken for 4-compartment fasciotomy for compartment syndrome. Following plastic surgery evaluation, patient then underwent excision of peroneus longus and brevis muscles, lateral gastrocnemius, lateral hemisoleus and partial excision of flexor hallucis longus with neurolysis of right common peroneal and superficial peroneal nerves. The patient then underwent multiple debridements and was discharged to acute rehabilitation.

Setting: Tertiary Care Hospital

Assessment/Results: He spent 10 days in acute rehab with wound VAC changes every three days and AFO at rest. His pain became well controlled with percocet as needed and up-titration of gabapentin. He was discharged at a modified independent level with plans for skin graft.

Discussion (relevance): To our knowledge, this is the first reported case of lower extremity compartment syndrome as a complication of Type A aortic dissection repair. Increased awareness is crucial as timely fasciotomy is vital to save the limb. Pain, bracing, wound care, and assistive devices are important aspects to manage in acute rehabilitation for lower extremity compartment syndrome with muscle excision.

Conclusions: Lower limb compartment syndrome is a potential complication following aortic dissection repair.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lower-extremity-compartment-syndrome-following-aortic-dissection-repair-a-case-report/