We report two cases of acute compartment syndrome in the anterior compartment of the lower limbs of patients with the diagnosis of Buerger disease associated with positive anticardiolipin antibodies. We comment on the rarity of the case and on the possibility of interference of two associated thrombogenic conditions. The need for early fasciotomy is emphasized since the progression to necrosis is time dependent. Fasciotomy was the only reperfusion surgery utilized on these patients with resolution of the ischemia.