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Alammari N, Ananthan B, Alotaibi S, Asiri Y, Mohammed M, Almulla A. A Rare Presentation of Pseudoaneurysm of the Popliteal Artery After Total Knee Replacement: A Case Report and Review of the Literature. Cureus 2024; 16:e65772. [PMID: 39211703 PMCID: PMC11361620 DOI: 10.7759/cureus.65772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Total knee replacement (TKR) is a common successful surgery in terms of the outcomes. The common complications of TKR are joint infection, deep venous thrombosis (DVT), wound complication, and postoperative knee instability. Arterial complications are not common. We are presenting a 61-year-old man who underwent left TKR. Upon postoperative regular follow-up, the patient developed symptoms and clinical presentation for DVT. However, initial duplex ultrasonography was negative for DVT. Repeated duplex ultrasonography showed a pseudoaneurysm of the popliteal artery, and the diagnosis was confirmed with computed tomography (CT) angiography. Pseudoaneurysm of the popliteal artery is a rare complication following primary TKR. Our patient underwent endovascular angioplasty and stenting of the pseudoaneurysm of the left popliteal artery. The patient completed three years and six months of follow-up with an uneventful course. We selected to share our experience of this rare case because pseudoaneurysm of the popliteal artery is a rare complication after TKR, which is usually present with symptoms that can mimic DVT, such as acute lower limb swelling, calf muscle pain, and pain with passive ankle dorsiflexion. Duplex ultrasonography is the preferred first diagnostic tool, and CT angiography (CTA) is needed to confirm the diagnosis and to plan treatment. Treatment with endovascular stent proved to be safe and successful with no infection risk or need for modifying rehabilitation protocol after more than three years of follow-up.
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Affiliation(s)
- Naji Alammari
- Orthopedics, King Fahad Specialist Hospital, Dammam, SAU
| | - Biju Ananthan
- Orthopedics, King Fahad Specialist Hospital, Dammam, SAU
| | - Saad Alotaibi
- Orthopedics, King Fahad Specialist Hospital, Dammam, SAU
| | - Yasser Asiri
- Musculoskeletal Radiology, Medical Imaging Services Center, King Fahad Specialist Hospital, Dammam, SAU
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Melian CM, Giannopoulos S, Tsouknidas I, Volteas P, Virvilis D, Nicholson J, Koullias GJ. Endovascular Repair Of Popliteal Artery Injury Post-Total Knee Arthroplasty is Safe and Effective: A Case Report And Systematic Review Of the Literature. Ann Vasc Surg 2023:S0890-5096(23)00105-X. [PMID: 36868455 DOI: 10.1016/j.avsg.2023.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Objective: Popliteal artery pseudoaneurysms are a rare but serious complication following total knee arthroplasty (TKA) that have been traditionally managed with open surgical repair. Endovascular stenting, while relatively new, offers a promising alternative that is less invasive and may reduce the risk of peri-operative complications. MATERIALS AND METHODS A systematic literature review was conducted and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, post-procedural complications and follow-up data were extracted and analyzed using STATA 14.1. Additionally, we present a case of a patient with a popliteal pseudoaneurysm treated with a covered endovascular stent. RESULTS A total of 14 studies (12 case reports, 2 case series; n= 17) were included for review. In all cases a stent-graft was placed across the popliteal artery lesion. In 5 out of 11 cases popliteal artery thrombus was present and treated with adjacent modalities (i.e. mechanical thrombectomy, balloon angioplasty, etc). Procedure success was reported in all cases without perioperative adverse events. Stents remained patent over a median follow up of 32 weeks (Interquartile range IQR: 36). In all but one case the patients experienced immediate symptom relief and had an uneventful recovery. For our case, at 12 months follow up the patient was asymptomatic, and ultrasound demonstrated vessel patency. CONCLUSION Endovascular stenting is a safe and effective treatment for popliteal pseudoaneurysms. Future studies should be aimed at evaluating the long-term outcomes of such minimally invasive techniques.
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Affiliation(s)
- Christina M Melian
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, Limb Preservation Center, Division of Vascular and Endovascular Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Ioannis Tsouknidas
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, Limb Preservation Center, Division of Vascular and Endovascular Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Dimitrios Virvilis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, Limb Preservation Center, Division of Vascular and Endovascular Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - James Nicholson
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - George J Koullias
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, Limb Preservation Center, Division of Vascular and Endovascular Surgery, Stony Brook University Hospital, Stony Brook, NY; Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
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Vascular Injuries During Hip and Knee Replacement. Orthop Clin North Am 2022; 53:1-12. [PMID: 34799015 DOI: 10.1016/j.ocl.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Vascular injuries associated with hip and knee arthroplasty are rare but can result in devastating outcomes for the patient. A sound knowledge of vascular anatomy, potential mechanisms of injury, and diagnosis and management of vascular injuries are vital to an arthroplasty surgeon. Identifying high-risk patients and procedures allows careful preoperative planning, which combined with meticulous intraoperative technique, may help avoid vascular complications. When vascular injuries do occur, early recognition and intervention are critical to an improved outcome.
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Schermer BA, Berger AC, Stomp W, van der Lugt JCT. Pseudoaneurysm of the Popliteal Artery After (Revision) Knee Arthroplasty. Arthroplast Today 2021; 13:1-6. [PMID: 34926745 PMCID: PMC8649579 DOI: 10.1016/j.artd.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022] Open
Abstract
Pseudoaneurysm of the popliteal artery is a rare complication of total knee arthroplasty (TKA), with a reported incidence of 0.0095% to 0.088%. We describe the case of a 66-year-old female who underwent conversion of unicompartmental knee arthroplasty (2014) to a TKA because of instability symptoms. A pseudoaneurysm of the popliteal artery was found postoperatively on ultrasound performed because of persistent symptoms of pain and tightness of her calf and hypesthesia of digits 3 to 5. She was treated endovascularly with placement of a covered stent. At the most recent follow-up (8 months after surgery), the complaints of hypesthesia persist. A pseudoaneurysm of the popliteal artery is a rare, yet well-described, complication of TKA often found coincidentally on Duplex ultrasound usually performed to rule out a deep venous thrombosis. Prompt diagnosis is of great importance given the potential to developing compartment syndrome or irreversible neurological deficits.
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Affiliation(s)
- Biko A Schermer
- Department of Orthopaedics, Reinier Haga Orthopedic Center, Zoetermeer, the Netherlands
| | - Arne C Berger
- Department of Orthopaedics, Reinier Haga Orthopedic Center, Zoetermeer, the Netherlands.,Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Wouter Stomp
- Department of Radiology, LangeLand Hospital, Zoetermeer, the Netherlands.,Department of Radiology, Haga Hospital, The Hague, the Netherlands
| | - Joris C T van der Lugt
- Department of Orthopaedics, Reinier Haga Orthopedic Center, Zoetermeer, the Netherlands.,Department of Orthopaedics, Haga Hospital, The Hague, the Netherlands
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5
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Sundaram K, Udo-Inyang I, Mont MA, Molloy R, Higuera-Rueda C, Piuzzi NS. Vascular Injuries in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 8:e0051. [PMID: 32105241 DOI: 10.2106/jbjs.rvw.19.00051] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Vascular injuries associated with total knee arthroplasty can have limb and life-threatening consequences. The aims of this study were to conduct a meta-analysis of the overall rate of vascular injuries after total knee arthroplasty and to conduct a systematic review of specific major and minor vessel injuries. METHODS All English-language literature published from January 1, 1998, to November 30, 2018, was queried in 4 unique databases using a common search term. This yielded 404 results, of which 270 were unique. Two reviewers then assessed studies for eligibility. All non-human studies, cadaver studies, studies describing only human images, and human studies with non-acute pathology were excluded. The final study included 10 large epidemiological studies and 68 case series or studies. Data from the literature were abstracted into a comma-separated database spreadsheet using Microsoft Excel. A meta-analysis was then performed. Pooled statistics were calculated with weighting by inverse variance assuming a random effect model. I was calculated as a quantifier of heterogeneity and interpreted according to the Cochrane manual. All data analysis was performed using R software. RESULTS Among the 1,419,557 total knee arthroplasties reported in 10 studies, there were 767 major vascular injuries (0.05% [54 per 100,000 total knee arthroplasties]). Amputation or long-term neurological complications occurred in approximately 21% of patients after major vascular injury. Presentation after 24 hours occurred in 36% of cases. The most frequently injured vessels were the geniculate arteries, popliteal artery, superficial femoral artery, and anterior tibial artery. The injuries that were most likely to result in amputation were femoral artery occlusion, popliteal artery transection, and popliteal artery arteriovenous fistula. CONCLUSIONS Amputation and long-term neurological complications are common complications after a vascular injury associated with a total knee arthroplasty. Preoperative consultation with vascular surgery physicians may be a prudent approach before a surgical procedure for patients with known peripheral vascular disease, diabetes, hypertension, or smoking; however, more data on risk factors are needed. Awareness by the surgical team and implementation of specific strategies during a surgical procedure such as gentle manipulation of the knee and careful retraction may further reduce the rate of injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kavin Sundaram
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
| | - Robert Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Daniels SP, Sneag DB, Berkowitz JL, Trost D, Endo Y. Pseudoaneurysm after total knee arthroplasty: imaging findings in 7 patients. Skeletal Radiol 2019; 48:699-706. [PMID: 30306198 DOI: 10.1007/s00256-018-3084-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/29/2018] [Accepted: 09/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the clinical presentation of arterial pseudoaneurysms following total knee arthroplasty (TKA) and their diagnostic imaging features on ultrasound and magnetic resonance angiography (MRA) in 7 patients. MATERIALS AND METHODS A search of our radiology report database from 2007 to 2017 yielded 7 patients with a pseudoaneurysm diagnosed by imaging after TKA. Clinical notes and imaging were reviewed. RESULTS All 7 patients were male and ranged in age from 53 to 68 (mean 61) years. All patients presented with a painful swollen knee and hemarthrosis within the first month following surgery. Five patients presented after primary TKA. One patient presented after explantation for septic arthritis and another after partial synovectomy for septic arthritis without explantation. Ultrasound identified the pseudoaneurysm as a hypoechoic or hyperechoic mass with a "yin-yang" appearance of turbulent arterial flow and associated complex joint effusion. On MRA, the pseudoaneurysm was a mass next to a parent artery showing avid contrast enhancement in the arterial phase that persisted into the venous phase and washed out in the late venous phase. Six pseudoaneurysms arose from lateral geniculate arteries and 1 from a medial geniculate artery. There were no popliteal artery pseudoaneurysms. Five patients were treated endovascularly, 1 patient thrombosed without intervention, and 1 patient was treated with open surgery. CONCLUSION Pseudoaneurysm is a potential source of a painful swollen knee with hemarthrosis or a drop in hematocrit after TKA and can be identified with either ultrasound or MRA.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
| | - Jennifer L Berkowitz
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
| | - David Trost
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.
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Ammori MB, Evans AR, Mclain AD. Popliteal Artery Pseudoaneurysm After Total Knee Arthroplasty. J Arthroplasty 2016; 31:2004-7. [PMID: 27021701 DOI: 10.1016/j.arth.2016.02.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/13/2016] [Accepted: 02/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Popliteal artery pseudoaneurysm is a rare complication after total knee arthroplasty. Early recognition is imperative in its management to prevent the subsequent development of compartment syndrome and soft tissue ischemia. The aim of this study was to evaluate the complication rate, recognition, and management of symptomatic popliteal artery pseudoaneurysm after total knee arthroplasty. METHODS Between January 2004 and October 2014, 7937 consecutive total knee arthroplasties were identified from the Theatre Management (Ormis) System and cross-referenced against 1304 radiology reports containing the key words "popliteal" and "aneurysm' identified from the Patient Archiving Communication System. RESULTS Seven patients (0.088%) were found to have had a symptomatic popliteal artery pseudoaneurysm. The median (range) interval between total knee arthroplasty and the radiological diagnosis of a pseudoaneurysm was 15 (7-27) days. Popliteal artery pseudoaneurysm was diagnosed on duplex imaging (n = 4), arteriogram (n = 2), and computed tomography angiogram (n = 1). Fasciotomies were undertaken in 3 patients. CONCLUSION The complication rate of popliteal artery pseudoaneurysm was comparable to the literature. Recognition was identified as a problem. An appreciation of the mechanisms of injury and an awareness of this potential complication among orthopedic surgeons are imperative in reducing the complication rate and interval to diagnosis. Popliteal artery pseudoaneurysm should be included in the differential diagnosis for patients with a clinical presentation of postoperative compartment syndrome or deep vein thrombosis, and examination of the popliteal pulse should be undertaken early.
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Ghazala CG, Elsaid TA, Mudawi A. Popliteal Artery Pseudoaneurysm with Secondary Chronic Common Peroneal Nerve Neuropathy and Foot Drop after Total Knee Replacement. Ann Vasc Surg 2015; 29:1453.e5-8. [DOI: 10.1016/j.avsg.2015.04.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 01/04/2015] [Accepted: 04/12/2015] [Indexed: 11/26/2022]
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Papadopoulos DV, Koulouvaris P, Lykissas MG, Giannoulis D, Georgios A, Mavrodontidis A. Popliteal artery damage during total knee arthroplasty. Arthroplast Today 2015; 1:53-57. [PMID: 28326371 PMCID: PMC4956686 DOI: 10.1016/j.artd.2015.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 11/16/2022] Open
Abstract
Injury of popliteal artery during total knee arthroplasty is a relatively rare complication. We report on one case of transverse semi-dissection of the popliteal artery during the tibial cut and one case of popliteal pseudoaneurysm formation caused by Hohmann retractors. Diagnosis was made early in the first case but it was delayed in the second due to misdiagnosis of deep vein thrombosis. Both injuries were managed eventually by open surgery. Postoperative clinical examination and ultrasound imaging confirmed the successful restoration of the blood flow. This case report also describes the classification system of the type of vascular damage and describes the mechanism, the clinical presentation, diagnostic modalities and treatment options for these rare complications of total knee arthroplasty surgery.
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Affiliation(s)
| | | | - Marios G Lykissas
- Department of Orthopedics, University Hospital of Ioannina, Ioannina, Greece
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Shin YS, Hwang YG, Savale AP, Han SB. Popliteal artery pseudoaneurysm following primary total knee arthroplasty. Knee Surg Relat Res 2014; 26:117-20. [PMID: 24944978 PMCID: PMC4061406 DOI: 10.5792/ksrr.2014.26.2.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/22/2013] [Accepted: 10/30/2013] [Indexed: 12/23/2022] Open
Abstract
An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.
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Affiliation(s)
- Young-Soo Shin
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeok-Gu Hwang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Abhijit Prakash Savale
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Alserr AHK, Antonopoulos CN, Papapetrou A, Kakisis JD, Brountzos E, Liapis CD. Endovascular Repair of Popliteal Artery Pseudoaneurysm With Arteriovenous Fistula After Knee Arthroscopy. Vasc Endovascular Surg 2013; 48:166-70. [PMID: 24302163 DOI: 10.1177/1538574413512379] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report a case of postarthroscopic popliteal artery pseudoaneurysm (PSA) with arteriovenous fistula (AVF; PSA-AVF) in a 53-year-old woman who presented with limb edema, pain, and bruit 1 year after arthroscopic meniscectomy. She was treated percutaneously by covered stent deployment. After 6 months of follow-up, the patient was asymptomatic, with patency of the stent and occlusion of the AVF. A review of the literature was also performed to investigate the prevalence of postarthroscopic PSAs and highlight the endovascular approach of treatment. Endovascular approach with covered stent appears to be less invasive and might be an effective and feasible way of treatment of postarthroscopic popliteal PSA-AVF.
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Affiliation(s)
- Ayman H. K. Alserr
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | | | | | - John D. Kakisis
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | - Elias Brountzos
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | - Christos D. Liapis
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
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Troutman DA, Dougherty MJ, Spivack AI, Calligaro KD. Updated strategies to treat acute arterial complications associated with total knee and hip arthroplasty. J Vasc Surg 2013; 58:1037-42. [PMID: 23747133 DOI: 10.1016/j.jvs.2013.04.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Traditional treatment of acute arterial complications associated with total knee arthroplasty (TKA) and total hip arthroplasty (THA) has generally included arteriography followed by open surgery. The purpose of this study was to describe our evolution from open surgery to preferential endovascular treatment for acute arterial complications of TKA and THA. METHODS We analyzed our computerized database registry and patient charts for vascular interventions associated with TKA and THA at a hospital with a large volume of orthopedic surgery to determine changing trends in endovascular intervention for these complications. RESULTS Between 1989 and 2012, 39,196 TKA (26,374 total: 23,205 primary; 3169 revisions) and THA (12,822 total: 10,293 primary; 2529 revisions) were performed. Vascular surgery consultation was provided for the treatment of acute ischemia, hemorrhage, ischemia with hemorrhage, and pseudoaneurysm formation. All interventions were performed within 30 days of joint replacement. A total of 49 (0.13%) acute arterial complications occurred over the 23-year period: 37 (76%) associated with TKA and 12 (24%) with THA. Arterial injury was detected on the same day as the orthopedic procedure in 28 patients, between postoperative days 1 and 5 in 18 patients, and between postoperative days 5 and 30 in three patients. The arterial complications caused ischemia in 28 patients (58%), hemorrhage in six (12%), ischemia with hemorrhage in six (12%), and pseudoaneurysm in nine (18%). Treatment included solely endovascular intervention in 12 (25%), failed endovascular treatment converted to open surgery in one (2%), and open surgery alone in 36 (73%) patients. Before 2002, only 6% (2/32; 2 TKA) of patients were successfully treated with endovascular intervention compared with 59% (10/17; 9 TKA, 1 THA) after June 2002 (P = .0004). There was no mortality, and limb salvage was achieved in all patients. CONCLUSIONS Although the majority of acute arterial complications after TKA and THA are diagnosed on the day of surgery, a high clinical awareness for acute arterial injury should also be present in the postoperative period. Although not always feasible, endovascular management is now our preferred treatment for injuries associated with TKA or THA. This offers substantially shorter time to vascular restoration, with less morbidity than open repair, and equivalent satisfactory outcomes.
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Chan DYS, Mees B, Robinson D, Pond F. Endovascular repair of popliteal artery pseudoaneurysm with covered stent following total knee joint replacement. ANZ J Surg 2013; 83:491-2. [DOI: 10.1111/ans.12188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Dexter Yak Seng Chan
- Department of Vascular Surgery; Austin Hospital; Heidelberg; Victoria; Australia
| | - Barend Mees
- Department of Vascular Surgery; Austin Hospital; Heidelberg; Victoria; Australia
| | - Domenic Robinson
- Department of Vascular Surgery; Austin Hospital; Heidelberg; Victoria; Australia
| | - Franklin Pond
- Department of Vascular Surgery; Austin Hospital; Heidelberg; Victoria; Australia
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