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Prophylactic and Therapeutic Fasciotomy for Acute Compartment Syndrome after Revascularization for Acute Lower Limb Ischemia—Renal and Wound Outcomes

Karonen, Emil LU orcid ; Eek, Frida LU ; Butt, Talha LU and Acosta, Stefan LU orcid (2023) In Annals of Vascular Surgery 88. p.154-163
Abstract

Background: Acute Compartment Syndrome (ACS) is a significant complication after revascularization for acute lower limb ischemia (ALI). High risk patients sometimes undergo prophylactic fasciotomy (PF) to prevent ACS. Patients that develop ACS undergo therapeutic fasciotomy (TF). The optimal timing of fasciotomy has been debated. The aim of this study was to describe and compare renal and wound outcomes in patients undergoing PF and TF. Methods: A retrospective cohort study including 76 patients undergoing PF (n = 40) or TF (n = 36) after revascularization for ALI between 2006 and 2018. Estimated glomerular filtration rate (e-GFR) was used to evaluate renal function and compare within (paired-samples t-test) and between (analysis of... (More)

Background: Acute Compartment Syndrome (ACS) is a significant complication after revascularization for acute lower limb ischemia (ALI). High risk patients sometimes undergo prophylactic fasciotomy (PF) to prevent ACS. Patients that develop ACS undergo therapeutic fasciotomy (TF). The optimal timing of fasciotomy has been debated. The aim of this study was to describe and compare renal and wound outcomes in patients undergoing PF and TF. Methods: A retrospective cohort study including 76 patients undergoing PF (n = 40) or TF (n = 36) after revascularization for ALI between 2006 and 2018. Estimated glomerular filtration rate (e-GFR) was used to evaluate renal function and compare within (paired-samples t-test) and between (analysis of variance) groups. Wound complications and healing time were compiled from the complete wound healing period and compared between groups with Pearson's chi-squared-and log-rank test, respectively. Results: E-GFR improved over the in-hospital period with 8.2 ml/min/1.73 m2 (95% confidence interval [CI] 2.4–14.1, P = 0.007) in the PF group and 4.4 ml/min/1.73 m2 (95% CI 1.2–7.7, P = 0.010) in the TF group, with no significant difference between the 2 groups (0.3 ml/min/1.73 m2, 95% CI −6.7 to 7.4, P = 0.93). The wound infection rate was higher after TF (PF = 60.6 % and TF = 82.4 %, P = 0.048), whereas rate of other wound complications (PF = 61.3 % and TF = 35.3%, P = 0.036) was higher after PF. Conclusions: Overall wound complications were high, whereas renal function improved during in-hospital stay. A more conservative approach to fasciotomy could avoid unnecessary fasciotomies and reduce wound complications, while holding the potential to sufficiently preserve renal function if fasciotomy is needed for ACS. This would be possible and safe if an early diagnosis and treatment of ACS can be ensured.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Vascular Surgery
volume
88
pages
10 pages
publisher
Springer
external identifiers
  • pmid:36058463
  • scopus:85139736195
ISSN
0890-5096
DOI
10.1016/j.avsg.2022.07.018
language
English
LU publication?
yes
id
d5c109bb-b97f-4c5a-b040-4940f3fac344
date added to LUP
2023-01-20 14:13:40
date last changed
2024-04-18 18:19:51
@article{d5c109bb-b97f-4c5a-b040-4940f3fac344,
  abstract     = {{<p>Background: Acute Compartment Syndrome (ACS) is a significant complication after revascularization for acute lower limb ischemia (ALI). High risk patients sometimes undergo prophylactic fasciotomy (PF) to prevent ACS. Patients that develop ACS undergo therapeutic fasciotomy (TF). The optimal timing of fasciotomy has been debated. The aim of this study was to describe and compare renal and wound outcomes in patients undergoing PF and TF. Methods: A retrospective cohort study including 76 patients undergoing PF (n = 40) or TF (n = 36) after revascularization for ALI between 2006 and 2018. Estimated glomerular filtration rate (e-GFR) was used to evaluate renal function and compare within (paired-samples t-test) and between (analysis of variance) groups. Wound complications and healing time were compiled from the complete wound healing period and compared between groups with Pearson's chi-squared-and log-rank test, respectively. Results: E-GFR improved over the in-hospital period with 8.2 ml/min/1.73 m<sup>2</sup> (95% confidence interval [CI] 2.4–14.1, P = 0.007) in the PF group and 4.4 ml/min/1.73 m<sup>2</sup> (95% CI 1.2–7.7, P = 0.010) in the TF group, with no significant difference between the 2 groups (0.3 ml/min/1.73 m<sup>2</sup>, 95% CI −6.7 to 7.4, P = 0.93). The wound infection rate was higher after TF (PF = 60.6 % and TF = 82.4 %, P = 0.048), whereas rate of other wound complications (PF = 61.3 % and TF = 35.3%, P = 0.036) was higher after PF. Conclusions: Overall wound complications were high, whereas renal function improved during in-hospital stay. A more conservative approach to fasciotomy could avoid unnecessary fasciotomies and reduce wound complications, while holding the potential to sufficiently preserve renal function if fasciotomy is needed for ACS. This would be possible and safe if an early diagnosis and treatment of ACS can be ensured.</p>}},
  author       = {{Karonen, Emil and Eek, Frida and Butt, Talha and Acosta, Stefan}},
  issn         = {{0890-5096}},
  language     = {{eng}},
  pages        = {{154--163}},
  publisher    = {{Springer}},
  series       = {{Annals of Vascular Surgery}},
  title        = {{Prophylactic and Therapeutic Fasciotomy for Acute Compartment Syndrome after Revascularization for Acute Lower Limb Ischemia—Renal and Wound Outcomes}},
  url          = {{http://dx.doi.org/10.1016/j.avsg.2022.07.018}},
  doi          = {{10.1016/j.avsg.2022.07.018}},
  volume       = {{88}},
  year         = {{2023}},
}