Acute forearm compartment syndrome following haemodialysis access fistula puncture in uraemia.

Abstract

Acute compartment syndrome is a well-described surgical emergency that requires immediate diagnosis and operative intervention. Vascular access-associated compartment syndrome is rarely reported in haemodialysis patients. The purpose of this article is to document evidence that catheter-related puncture, which results in arteriovenous fistula injury in uraemia, may cause acute forearm compartment syndrome. Between September 2007 and September 2012, five consecutive patients presented to our section with tense swollen forearms with skin blistering, decreased hand sensation and reduced capillary return in the fingers. Their ages ranged from 65 to 81 years (mean 72.8 years). All of the patients underwent emergent exploration after the diagnosis of acute forearm compartment syndrome. The patients' details were reviewed. The time interval between dialysis completion and return to the emergency department ranged from 6 to 9 h (mean 7.4 h). During operation, the bleeding was found to originate from the site of the fistula puncture and was repaired with 9-0 nylon suture under microscopy. After adequate wound care, a reconstructive procedure with a split-thickness skin graft was performed in all of the five patients. There was no vascular or neurological deficit of the forearm or hand within the mean follow-up period of 14.8 months (range 12-18 months). In this series, we report five cases of forearm compartment syndrome in uraemia, secondary to bleeding from a catheter-related puncture of a haemodialysis access fistula. However, there is no case series that focuses upon this specific topic in the present literature. This problem deserves more attention.