Hello, my name is Hillary Ramroop and my poster is on a case report of compartment syndrome in a patient on rivaroxaban with severe peripheral arterial disease. This patient was an 84-year-old male with peripheral arterial disease, two left femoral stents, atrial fibrillation on rivaroxaban who presented with severe left lower extremity pain. He denied trauma to the area and inciting factors. CAT scan of the left lower extremity revealed a left soleus intramuscular hematoma with diffuse soft tissue edema of the left calf. He was diagnosed with acute compartment syndrome and underwent a four compartment emergent fasciotomy and had two wound vacuums placed. Subsequently, he was admitted to the acute inpatient rehabilitation unit and allowed to be weight-bearing as tolerated. He previously ambulated independently with a single-axis cane. In the center of the poster are a few images from the CAT scan of the lower extremities showing the left soleus intramuscular hematoma and diffuse soft tissue swelling in the left calf as depicted by the arrows. An arterial duplex study revealed non-occlusive material near the femoral stent with limited blood flow as well as extensive calcification of the anterior and posterior tibial arteries indicating severe lower extremity peripheral arterial disease. The patient's pain improved following fasciotomy and he achieved a contact guard level of ambulation with the rolling walker upon discharge from acute hospital. Acute compartment syndrome commonly occurs after trauma, mainly with long bone fractures. However, it can occur with non-traumatic events as well. It occurs when fascial compartment pressures exceed perfusion pressure, resulting in tissue ischemia and ultimately necrosis. This is a surgical emergency and requires immediate fasciotomy to release the involved muscular components. Patients can develop what's known as the six Ps of compartment syndrome, pain out of proportion to injury, paresthesias, oiculotherma, pallor, pulsenessness, and paralysis. Rivaroxaban, also known as Xarelto, is commonly used for treatment of atrial fibrillation and deep vein thrombosis. It has been preferred over Warfarin as it does not require frequent monitoring and is just as effective. Previously there was no reversal drug for uncontrollable bleeding due to Rivaroxaban. A few years ago, Andexanet-alpha was approved for uncontrollable bleeding. However, the efficacy is still in question and there are still ongoing clinical trials. Rivaroxaban has no risk of bleeding and few studies have been published regarding atraumatic spontaneous bleeding resulting in compartment syndrome. Arterial bleeding can result in increased compartment pressures, causing muscle ischemia. Severe arterial disease, as occurs with peripheral arterial disease, can contribute to the formation of collateral circulation and lead to muscle ischemia and tissue compromise. The acutely ischemic muscle is prone to injury once flow is reestablished. Clinical rehabilitation goals should include proper wound care to prevent infection, minimizing post-operative swelling, and passive range of motion exercises. Patients can perform leg lifts to maintain hip strength, perform gentle stretching, and resistance exercises. In conclusion, acute compartment syndrome is a limb and life-threatening surgical emergency. It is important to note that even though traumatic injuries are the most common cause, spontaneous bleeding into the leg can alter fascial compartment pressures. This in combination with severe peripheral arterial disease can lead to compartment syndrome.

compartment syndrome

peripheral arterial disease

rivaroxaban

acute compartment syndrome

non-traumatic causes