Risk Factors for Post-Lytic Therapy Compartment Syndrome in Acute Limb Ischemia
Juan B. Umana-Pizano, MD, Hunter M. Ray, MD, Stuart A. Harlin, MD.
University of Texas Health Science Center at Houston, Houston, TX, USA.
OBJECTIVES: To determine possible factors to predict post-lytic therapy lower extremity compartment syndrome after reperfusion in acute limb ischemia (ALI).
METHODS: All patients that underwent arterial lytic therapy (ALT) at our hospital from May 2017 to June 2018 were identified and retrospectively analyzed. Patients were stratified according to whether or not they developed compartment syndrome (CS) requiring fasciotomy. Differences between groups were calculated with R software; continuous normally distributed variables were analyzed with student-t test, continuous non-normal variables with Man-Whitney U-test and categorical variables were with Fisher exact test.
RESULTS: 17 patients with ALI underwent ALT, 3 (18%) developed CS that required fasciotomy. There were no statistically significant differences between groups in patient characteristics, mean age was 65.1 and 60.1 (p=0.54) for non-CS (NCS) and CS groups respectively. The only statistically significant difference in pre-procedure variables was the presence of higher median white blood cell count in patients with CS (11,033 versus 7,623 wbc/mcL, p=0.029). Pre-procedure CK and CRP had non-significant differences between groups (p= 0.876 and 0.485. Table 1. Post-procedure outcomes were similar in both groups; 30-day amputation rates (0% NCS versus 33.3% CS, p=0.187) and 30-day re-intervention rates (7.7% NCS versus 0% CS, p=1), there was no mortality. Intra and post-procedure variables are presented in Table 1.
CONCLUSIONS: This results demonstrates the apparent importance of pre-procedure white blood cell counts as a risk factor for post-procedure CS. Further studies are warranted.
| Variable | Non-Compartment Syndrome (n=14) | Compartment Syndrome (n=3) | p-value |
| Initial White Blood Cell Count, mean(SD) | Initial White Blood Cell Count, mean(SD) | 2 (66.7) | 1 |
| Initial White Blood Cell Count, mean(SD) | 11 (78.6) | 2 (66.7) | 1 |
| Initial White Blood Cell Count, mean(SD) | 7,623.1 (2051.0) | 11,033.3 (2853.7) | 0.029 |
| Initial Creatinine Kinase, median(IQR) | 97.0 [69.0, 135.5] | 105.0 [73.0, 124.5] | 0.876 |
| Initial C-Reactive Protein, median(IQR) | 2.8 [2.8, 6.4] | 5.8 [5.8, 5.8] | 0.485 |
| Duration of Symptoms, median(IQR) | 7.0 [1.5, 10.0] | 1.0 [0.7, 2.5] | 0.12 |
| Hours of Therapy, mean(SD) | 29.7 (19.0) | 52.3 (13.9) | 0.074 |
| Amputation 30 days, n(%) | 0 (0.0) | 1 (33.3) | 0.187 |
| Reintervention 30 days, n(%) | 1 (7.7) | 0 (0) | 1 |
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