Evaluation and Management of Peripheral
Annotation for Point Q
When the completion arteriogram documents narrowing or a ‘‘beaded’’ appearance of the vessels in the leg, either a compartment syndrome or a spasm is present. If the surgeon is convinced that a compartment syndrome is present based on the history (delay in treatment), physical examination (significant swelling of the leg or forearm; neuromuscular findings — see C), or operative findings (need for simultaneous arterial and venous clamping, venous ligation), a fasciotomy is performed.13 When the presentation is less clear to the surgeon, a compartment pressure is measured. A compartment pressure of 30 mm Hg in the patient with an abnormal postrepair arteriogram would prompt a fasciotomy on most trauma services.