Lee Wei-Yang, Hsu Hsiang-Hao, Yen Tzung-Hai, Wang Li-Jen, Lee Shen-Yang
Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Gueishan, Taoyuan, Taiwan.
Ann Vasc Surg. 2013 Jan;27(1):111.e1-3. doi: 10.1016/j.avsg.2012.04.016. Epub 2012 Sep 12.
Acute compartment syndrome of the upper limb due to dialysis access-related bleeding is a rare and severe complication of hemodialysis. In most reported cases, this complication is caused by an enlarging hematoma after puncture or perforation of a fistula in combination with the use of heparin. In this case report, we describe a 52-year-old woman presenting with venous hypertension and left-arm swelling that progressed suddenly on the fifth day of presentation to neurological deficits, cyanotic skin changes, and typical clinical symptoms of acute arm compartment syndrome. An angiographic scan confirmed a critical stenosis at the proximal cephalic-axillary venous junction, and balloon angioplasty successfully dilated the lesion. The arm swelling and other symptoms subsided dramatically within 3 days. This case represents a potentially different mechanism for the development of acute arm compartment syndrome in dialysis patients as well as a treatment strategy different from standard fasciotomy to reduce intracompartmental pressure.
透析通路相关出血所致上肢急性骨筋膜室综合征是血液透析一种罕见且严重的并发症。在大多数报道的病例中，这种并发症是由穿刺或瘘管穿孔后血肿扩大并联合使用肝素引起的。在本病例报告中，我们描述了一名52岁女性，其表现为静脉高压和左臂肿胀，在就诊第5天突然进展为神经功能缺损、皮肤发绀改变以及典型的急性手臂骨筋膜室综合征临床症状。血管造影扫描证实头静脉-腋静脉近端交界处存在严重狭窄，球囊血管成形术成功扩张了病变部位。手臂肿胀和其他症状在3天内显著消退。该病例代表了透析患者急性手臂骨筋膜室综合征发生的一种潜在不同机制，以及一种不同于标准筋膜切开术以降低骨筋膜室内压力的治疗策略。
