Compartment Syndrome and Intraaortic Balloon

Summary

Intraaortic balloon (IAB) is a well accepted and useful therapeutic option; the complications reported with it's use are varied. We have observed 4 patients over a period of 6 years, who developed swollen tender calves and loss of sensation and/or function, yet who retained a warm limb with palpable peripheral pulses during or immediately after IAB pumping. At fasciotomy, they had bulging ischemic muscles. We hypothesize that this is compartment syndrome following temporary or partial ischemia due to balloon placement. We have prospectively studied 13 patients by measuring the pressure in the anterior compartment of the lower limb using the slit catheter technique. In 11 of these patients with no evidence of complications, pressure measurements remained below 7 mmHg. In one patient showing signs consistent with compartment syndrome, pressures up to 35 mmHg were recorded and at fasciotomy, the diagnosis was confirmed. A second patient with signs suggestive of compartment syndrome, had pressures below 15 mmHg. This patient was treated conservatively with resolution of the condition. Compartment syndrome after IAB placement has only been rarely described. We believe this is due to inadequate diagnosis and that slit catheter pressure measurements are a valuable tool in its management. We encountered no complications associated with the technique.

Key words

Intra-aortic balloon - Compartment syndrome - Slit catheter