Acute left-arm compartment syndrome due to cephalic arch stenosis in a dialysis patient

Acute compartment syndrome of the upper limb due to dialysis access-related bleeding is a rare and severe complication of hemodialysis. In most reported cases, this complication is caused by an enlarging hematoma after puncture or perforation of a fistula in combination with the use of heparin. In this case report, we describe a 52-year-old woman presenting with venous hypertension and left-arm swelling that progressed suddenly on the fifth day of presentation to neurological deficits, cyanotic skin changes, and typical clinical symptoms of acute arm compartment syndrome. An angiographic scan confirmed a critical stenosis at the proximal cephalic-axillary venous junction, and balloon angioplasty successfully dilated the lesion. The arm swelling and other symptoms subsided dramatically within 3 days. This case represents a potentially different mechanism for the development of acute arm compartment syndrome in dialysis patients as well as a treatment strategy different from standard fasciotomy to reduce intracompartmental pressure.