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[Acute forearm compartment syndrome after total arch replacement].

Ikutaro Kigawa¹, Takeshi Miyairi, Satona Tanaka

¹Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery

|June 21, 2011

Summary

Aortic arch surgery can lead to left subclavian artery occlusion and acute compartment syndrome (ACS). Prompt fasciotomy and decompression are crucial for functional recovery after this rare complication.

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Area of Science:

Cardiovascular Surgery
Vascular Surgery
Thoracic Surgery

Background:

A 61-year-old female with aortic regurgitation and aortic arch aneurysm underwent a Bentall operation and total arch replacement.
The complex procedure involved a branched prosthesis for aortic arch reconstruction.

Observation:

Postoperatively, the patient experienced left forearm hypesthesia and paresis, attributed to left subclavian artery (LSA) occlusion.
Imaging confirmed LSA occlusion, necessitating emergency reoperation with axillary artery bypass grafting.

Findings:

Despite revascularization, the patient rapidly developed acute compartment syndrome (ACS) of the forearm.
Emergency decompression fasciotomy was performed 15 hours after the initial surgery.

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Implications:

The rapid ACS progression was linked to prolonged ischemia and venous obstruction from left brachiocephalic vein ligation.
Complete and immediate decompression, including deep forearm compartments, is vital for successful ACS management and functional recovery.