PC098. Reassessing the Role of Fasciotomy After Revascularization of Nontraumatic Acute Lower Limb Ischemia

The use of fasciotomies to prevent complications of compartment syndrome after the treatment of acute limb ischemia is widespread; however, minimal objective data support this practice. We present a single-institution experience in which fasciotomies are not regularly performed after revascularization. Using International Classification of Diseases, Ninth Revision and Tenth Revision codes, we identified all patients presenting to UC Davis Medical Center between January 2003 and July 2018 with acute limb ischemia, excluding those with traumatic injuries. Primary outcomes were amputation and new motor deficit. In addition, we summarized our findings in those patients with and without fasciotomies, excluding those with grade III ischemia. We identified 275 limbs treated for acute limb ischemia. Of these, 22 had grade III ischemia and 253 had Rutherford grade I (52), grade IIa (92), or grade IIb (109) ischemia. Of these, 230 (91%) were successfully revascularized, whereas 23 had nonreconstructible disease (Table). The overall amputation rate was 8% (2.6% of revascularized limbs and 65% of nonreconstructible limbs). A total of 11 fasciotomies were performed in the successfully revascularized limbs. Of the 230 limbs with reconstructible disease, 135 limbs had grade I/IIa ischemia and 95 limbs had grade IIb ischemia; 134 of the 135 Rutherford grade I/IIa ischemic limbs did not undergo fasciotomy after revascularization. In this group, 102 limbs (76%) presented with ischemic symptoms >6 hours. Retained motor function after revascularization was seen in 95% of these limbs. New-onset footdrop occurred in 2 of 102 limbs (2%) with >6 hours of ischemic symptoms and none with <6 hours. In the 95 limbs with grade IIb ischemia (Fig), 65 had >6 hours of symptoms. Of these, 58 did not receive a fasciotomy, and 69% of these limbs had improved motor function, 14% had persistent motor deficit, and 7% were amputated. Of the seven receiving fasciotomy, 43% experienced improved motor function, whereas 14% had persistent footdrop, and there were no amputations. In the 30 limbs with <6 hours of ischemic symptoms, 27 did not have a fasciotomy, and 74% of these had improved motor function, 11% had persistent footdrop, and 4% were amputated. Of the three receiving fasciotomy, 67% had improved motor function, and there were no persistent motor deficits or amputations. Our experience demonstrates an acceptable amputation rate and low rate of new-onset motor dysfunction in salvageable limbs, thereby suggesting that fasciotomies may not always be necessary in patients who present with acute limb ischemia due to isolated arterial occlusion.TableOutcomes by Rutherford gradeRutherford INo fasciotomy (n = 48), No. (%)Fasciotomy (n = 0), No. (%)Prolonged ischemia (>6 hours)37 (77.1)0Preserved motor function46 (95.8)0Motor dysfunction1 (2.1)0Amputation00Death1 (2.1)0Rutherford IIaNo fasciotomy (n = 86), No. (%)Fasciotomy (n = 1), No. (%)Prolonged ischemia (>6 hours)65 (75.6)0Preserved motor function81 (94.2)0Motor dysfunction1 (1.2)0Amputation01Death4 (4.7)1Rutherford IIbNo fasciotomy (n = 85), No. (%)Fasciotomy (n = 10), No. (%)Prolonged ischemia (>6 hours)58 (68.2)7 (70.0)Improved motor function60 (70.6)5 (50.0)Motor dysfunction11 (13.9)1 (10.0)Amputation5 (5.9)0Death9 (10.6)4 (40.0)Excludes limbs with nonreconstructable disease. Open table in a new tab