Gluteal Compartment Syndrome Following Abdominal Aortic Aneurysm Repair

Abstract

Gluteal compartment syndrome (GCS) is one of the rare complications of abdominal aortic aneurysm (AAA) repair. GCS requires prompt diagnosis and early treatment. Here, we report a case of GCS after AAA repair. A 79-year-old male underwent an endovascular abdominal aortic repair (EVAR) with right internal iliac artery embolization for an asymptomatic 5.7-cm right common iliac artery aneurysm (CIAA) at our hospital 6 years ago. Follow-up computed tomography (CT) revealed an enlarged CIAA due to type II endoleak from the lumbar arteries. Open surgical repair was performed, and open ligation of the culprit lumbar artery causing the type II endoleak was attempted but the surgical plan was converted to prosthetic graft replacement due to strong intra-abdominal adhesions. The patient complained of severe pain in the left buttock and presented with swelling in the left buttock and left lower paresthesia 2 days postoperatively. CT revealed swollen gluteus muscles, and the left gluteal compartment pressure was measured as 110-120 mmHg. We diagnosed a GCS and performed surgical decompression and debridement of the left gluteal compartments urgently. Postoperatively, renal function gradually improved although the patient required hemodialysis, resulting in left sciatic nerve palsy.