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All Journal CRJIM (Clinical and Research Journal in Internal Medicine) Deka in Medicine
Afifuddin, Mokhammad
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Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other

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Compartment syndrome as reperfusion injury following thrombectomy in acute limb ischemia: A case report Afifuddin, Mokhammad; Kurnianingsih, Novi; Kurniawan, Dea
Deka in Medicine Vol. 1 No. 2 (2024): August 2024
Publisher : PT. DEKA RESEARCH INSTITUTE

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69863/dim.2024.e209

Abstract

BACKGROUND: Compartment syndrome following reperfusion in acute limb ischemia represents a rare but serious complication. Thus, documenting such cases is essential to enhance comprehension and management of this condition. CASE PRESENTATION: A 51-year-old man was referred from an urban hospital presenting with severe right leg pain persisting for 5 days prior to admission, accompanied by pulselessness, paresthesia, poikilothermia, and paralysis. The patient had underlying risk factors including uncontrolled diabetes mellitus and active smoking. Duplex ultrasound confirmed the diagnosis of acute limb ischemia, which was further supported by CT angiography revealing total occlusion from the right common iliac artery to the distal region. Intravenous heparin was administered, and the patient underwent emergency surgical thrombectomy. Following the intervention, the patient developed clinical signs of compartment syndrome as a manifestation of reperfusion injury, necessitating fasciotomy. Subsequent evaluation of the wound post-fasciotomy indicated it was not suitable for closure, and unfortunately, the patient passed away a few days later. CONCLUSION: This case illustrates acute limb ischemia necessitating thrombectomy and surgical fasciotomy due to compartment syndrome resulting from reperfusion injury, emphasizing the importance of rigorous monitoring.
Optimizing Cardiac Rehabilitation for Patients with Complex Coronary Disease without Revascularization Afifuddin, Mokhammad; Tjahjono, Cholid Tri; Mayangsari, Veny
Clinical and Research Journal in Internal Medicine Vol. 6 No. 2 (2025): Volume 6 No 2, November 2025
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2025.006.02.10

Abstract

Patients with complex coronary artery disease (CAD) ineligible for revascularization present considerable management challenges and a high ischemic burden. Cardiac rehabilitation (CR), a comprehensive, multidisciplinary intervention, emerges as an essential non-pharmacological therapy. This review synthesizes the principles of CR, focusing on its profound pathophysiological benefits in this specific cohort. Mechanistically, CR confers pleiotropic effects: it enhances endothelial function via the eNOS/NO pathway, mitigates systemic inflammation through myokine regulation, promotes coronary collateralization (HIF-1α/VEGF pathway), and restores autonomic balance (HRV). Furthermore, CR integrates essential psychosocial support to address the high prevalence of depression and anxiety, which are independent risk factors. A primary objective, the improvement of quality of life (QoL), is consistently achieved through reduced anginal symptoms and enhanced functional status. Despite robust clinical and economic evidence demonstrating CR's efficacy in reducing MACE, mortality, and healthcare utilization, significant barriers to referral and adherence persist. Vigilant supervision and protocol adaptations are mandated for high-risk anatomical subsets, such as those with chronic total occlusions or severe left ventricular dysfunction
Co-Authors Cholid Tri Tjahjono Kurnianingsih, Novi Kurniawan, Dea Mayangsari, Veny