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• W3094611145 abstract "It is not often that the Journal publishes a review of 121 articles concerned with two treatment options where the conclusion implies a total lack of consensus. However, that is the case with this article evaluating fasciotomy vs conservative therapy for chronic exertional compartment syndrome.1Ding A. Machin M. Onida S. Davies A.H. A systematic review of fasciotomy in chronic exertional compartment syndrome.J Vasc Surg. 2020; 72: 1802-1812Abstract Full Text Full Text PDF Scopus (12) Google Scholar One may ask, Why did the editors choose to publish this analysis? The answer is that chronic exertional compartment syndrome is increasingly being diagnosed and treated not only by orthopedic surgeons but also by vascular surgeons, many of whom may have limited experience with this condition. Chronic exertional compartment syndrome can be debilitating, especially for professional athletes. Therefore, it is imperative that vascular surgeons consider the diagnosis in patients who present with lower extremity exercise-induced discomfort with minimal risk factors for atherosclerosis. Most of these sufferers are involved in high-intensity exercise activities, but even somewhat sedentary patients can exhibit the classic symptoms of pain, tightness, cramping, weakness, and paresthesia. Physical findings during exercise may be negligible, but sometimes calf tenderness or fullness may be elicited. Findings on typical noninvasive tests, such as ankle-brachial pressure indices with and without exercise, arterial duplex ultrasound, and computed tomography angiography evaluation of arterial anatomy, are usually normal. The only test proposed to have some diagnostic utility is intracompartment pressures, as described by Pedowitz et al.2Pedowitz R.A. Hargens A.R. Mubarak S.J. Gershuni D.H. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg.Am J Sports Med. 1990; 18: 35-40Crossref PubMed Scopus (381) Google Scholar Criteria for diagnosis are discussed in the manuscript of Ding et al. Although one could make a home-made measuring device, there is a commercially available test kit (STIC pressure monitor) made originally by Stryker and now supplied by C2Dx (Schoolcraft, Mich). Because most of these patients are predominantly diagnosed on an outpatient basis, vascular surgeons should become familiar with this device and incorporate it in their office laboratories. The question remains, however, whether patients should have a fasciotomy or conservative therapy. Fasciotomy intuitively makes sense, but there are cosmetic side effects as well as complications, including hematoma, deep venous thrombosis, infection, and nerve damage. Furthermore, as many as 10.4% of patients reviewed required revision fasciotomy, and satisfaction rates for compartment decompression range from 48% to 94% (but 94% was for upper extremity decompressions). Currently, there is no randomized controlled clinical trial comparing these two treatment methods. Furthermore, the certainty of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation was low. Not surprisingly, then, despite this extensive review, fasciotomy or conservative therapy remains controversial. The authors are accordingly forced to conclude with a nebulous statement, much like we are currently hearing from politicians about drugs for COVID-19. Definitive information in the form of a randomized controlled trial is “being carried out,” but for now, fasciotomy appears safe with promising long-term results. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. A systematic review of fasciotomy in chronic exertional compartment syndromeJournal of Vascular SurgeryVol. 72Issue 5PreviewChronic exertional compartment syndrome (CECS) is an overuse injury typically seen in young and athletic patients. The five cardinal symptoms are pain, tightness, cramping, weakness, and paresthesia. These classically occur during exertion and disappear with cessation of the activity, with no permanent damage to tissues within the compartment; nonetheless, CECS presents a significant functional impairment to those affected. Regulating exercise has been shown to alleviate symptoms, but this may not be acceptable to some patients (eg, professional athletes). Full-Text PDF Open Archive" @default.
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• W3094611145 title "Fasciotomy for chronic exertional compartment syndrome remains controversial" @default.
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• W3094611145 doi "https://doi.org/10.1016/j.jvs.2020.06.108" @default.
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