Subfascial hematoma progressed to arm compartment syndrome due to a nontransposed brachiobasilic fistula.
Vascular access-associated compartment syndrome is reported rarely in hemodialysis patients. A 62-year-old female hemodialysis patient experienced left-arm compartment syndrome caused by a nontransposed brachiobasilic arteriovenous fistula. A subfascial hematoma that developed because of perforation of the posterior wall of the basilic vein was not detected by Doppler ultrasound initially, and subsequent heparinized hemodialysis caused progression of the hematoma. Neuromuscular sequelae were prevented by performing an emergent fasciotomy, and transposition of the arterialized basilic vein was performed later to prevent similar complications in the future. This case report shows the risk for the occurrence of such a devastating complication if the nontransposed brachiobasilic fistula is used for hemodialysis vascular access.
Wang
Kang-Ling
KL
Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Li
Szu-Yuan
SY
Chuang
Chiao-Lin
CL
Chen
Tzen-Wen
TW
Chen
Jinn-Yang
JY
D001132:Arm; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003161:Compartment Syndromes / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D018450:Disease Progression; D000071938:Fasciotomy; D005260:Female; D006406:Hematoma / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D006435:Renal Dialysis; D014057:Tomography, X-Ray Computed