A 67-year-old man was admitted with traumatic arterial occlusion in his leg 24 h after an accident. A double-lumen catheter was inserted into the left iliac vein, after revascularization, and haemodialysis started using a new membrane dialyser to remove myoglobin effectively. Intramuscular pressure of the limb was measured and, when it was 35 mmHg, staged fasciotomy was performed. A modification of the procedure used to prevent myonephropathic metabolic syndrome and compartment syndrome is described.
SennAAlthausU. Revascularization syndrome after embolectomy. J Cardiovasc Surg (Torino)1973;14: 632–4.
3.
HaimoviciH. Muscular, renal, and metabolic complications of acute arterial occlusions: myonephropathic metabolic. syndrome. Surgery1979;85: 461–8.
4.
PatmanRDThompsonJE. Fasciotomy in peripheral vascular surgery. Arch Surg1970;101: 663–72.
5.
HarrisKWalkerMMickleDAG. Metabolic response of skeletal muscle to ischemia. Am J Physiol1986;250: H213–20.
6.
KorthuisRJGrangerDNTownsleyMI. The role of oxygen-derived free radicals in ischemia-induced increases in canine skeletal muscle vascular permeability. Circ Res1985;57: 600–9.
7.
WalkerPMLindsayTFLabbeR. Salvage of skeletal muscle with free radical scavengers. J Vasc Surg1987;5: 68–75.
8.
DierbergWJBrownOW. Rapid measurement of compartment pressure: a new technique. Vasc Surg1990;24: 277–80.
9.
AdachiSNakajimaNAdachiT. Myonephropathic metabolic syndrome after revascularization of acute arterial occlusion of lower extremities. Journal of Japanese Cardiovascular Surgery1988;17: 474–7 (in Japanese).
10.
BlebeaJKerrJCShumkoJZ. Quantitative histochemical evaluation of skeletal muscle ischemia and reperfusion injury. J Surg Res1987;43: 311–21.
11.
BlaisdellFWSteeleMAllenRE. Management of lower extremity arterial ischemia due to embolism and thrombosis. Surgery1978;84: 822–34.
12.
LarcanAMathieuPHelmerJ. Severe metabolic changes following delayed revascularization: Legrain-Cormier syndrome. J Cardiovasc Surg (Torino)1973;14: 609–14.
13.
EneasJFSchoenfeldPYHumphreysMH. The effect of infusion of mannitol-sodium bicarbonate on the clinical course of myoglobinuria. Arch Intern Med1979;139: 801–5.
