Preoperative risk factors for acute compartment syndrome in non-traumatic acute lower limb ischemia

Post-reperfusion compartment syndrome (CS) is a serious complication that may occur after the revascularization of patients with acute limb ischemia (ALI). This study aims to explore the risk factors associated with CS, providing additional insights that can assist surgeons in making decisions regarding the necessity of prophylactic fasciotomy or intensive monitoring post-revascularization.

This retrospective observational cohort study reviewed patients with ALI whom was underwent revascularization at our institution from January 2006 to December 2020. Patients with ALI in Rutherford classes I, IIa, and IIb, aged 15 years and older were included. Patients with upper extremities ischemia, patient with severity in Rutherford Class III and prior prophylactic fasciotomy were excluded from the study. The definition of post-reperfusion CS was a patient who was diagnosed with ALI and developed acute CS after revascularization.

Among 259 patients with acute limb ischemia, 28 (10.8%) developed post-reperfusion CS. Univariable analysis identified several risk factors, including platelet count <200,000/mm³, CK>510 U/L, serum CO2<20 mmol/L, and Rutherford class IIb ischemia. Multivariable analysis confirmed independent associations for body weight >83 kg (IRR 4.24, P=0.007), moderate to severe liver disease (IRR 14.41, P<0.001), low platelet count (IRR 2.38, P=0.027), and CK>510 U/L (IRR 3.17, P=0.005). Serum CO2<20 mmol/L approached significance (P=0.051). No significant differences were observed in 30-day amputation-free survival or mortality.

Higher body weight, liver dysfunction, thrombocytopenia, and elevated CK levels are independent predictors of post-reperfusion compartment syndrome. Early identification of at-risk patients may guide monitoring and intervention to prevent this serious complication.