title: Acute left-arm compartment syndrome due to cephalic arch stenosis in a dialysis patient.
abstract: 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.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Gueishan, Taoyuan, Taiwan.
authors.forename: Wei-Yang
authors.initials: WY
authors.lastname: Lee
authors.forename: Hsiang-Hao
authors.initials: HH
authors.lastname: Hsu
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Wang
authors.forename: Shen-Yang
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003161:Compartment Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003251:Constriction, Pathologic; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D006435:Renal Dialysis; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014690:Venous Pressure