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Abstract
Acute atraumatic compartment syndrome is a rare entity; of the peroneal
compartment, it is even rarer and bilateral even more so. We present the case of a
patient who underwent surgery to rescue a brachiocephalic mega-fistula with three
aneurysms associated with a stenosis of the cephalic arch. The technique consisted of
aneurysmectomy, removal of the excess vein, transposition, and a new anastomosis
distal to the axillary vein. The procedure lasted 220 minutes, and general anesthesia
was used. The following day, the patient reported left leg paraesthesia, pain, and
inability to evert the left foot or walk. Arterial pulses were normal, as was pulse
wave Doppler. MRI confirmed peroneal compartment syndrome, and an emergency
fasciotomy was performed. While recovering with full sensation and motility for
the next 24 hours on the left side, she presented with pain and cramps in the right
peroneal compartment without more severe symptoms, so fasciotomy was not
performed; the condition resolved spontaneously within 24 hours. This is the first
reported case of atraumatic bilateral peroneal compartment syndrome after dialysis
access surgery, with full recovery after prompt treatment.
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