Successful Endovascular Treatment of an Infected External Iliac Pseudoaneurysm with Hemorrhage at Total Hip Arthroplasty

Life-Threatening, Bleeding Pseudoaneurysm of the External Iliac Artery in the Setting of an Infected Total Hip Arthroplasty from Pasteurella multocida

We present a bleeding, infected (mycotic) pseudoaneurysm from the organism Pasteurella multocida. The patient presented septic from an infected total hip arthroplasty and was treated with surgical debridement, component retention, and antibiotics. She re-presented with hip pain and a marked hemoglobin decrease. Vascular studies revealed a pseudoaneurysm of the external iliac artery and large hematoma secondary to contiguous spread of her hip infection. The pseudoaneurysm was treated with an endovascular stent before further debridement surgery to avoid exsanguinating hemorrhage with surgical release of her tamponade. This case demonstrates the utmost importance of recognizing and treating vascular pathology in a patient with an infected prosthetic hip, large hematoma, and decreased hemoglobin.

External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation

Vascular injury as a result of total hip arthroplasty (THA) represents an uncommon complication. Although these injuries typically present acutely, delayed presentation has been reported. In this case, a 70-year-old female presented with groin pain and medial thigh numbness 15 years after a left THA. After initially being misdiagnosed, repeat imaging revealed a large external iliac pseudoaneurysm as a result of a transacetabular screw penetrating the medial acetabular wall. The patient underwent staged endovascular exclusion of the pseudoaneurysm, percutaneous drainage, and revision THA. She had resolution of her symptoms. To our knowledge, this is the only reported case of a late vascular injury related to an aseptic THA with well-fixed components. Staged treatment with endovascular exclusion and revision THA is a viable approach.

Pseudoaneurysm rupture with hemorrhagic shock in a patient with periprosthetic hip joint infection: A case report

RATIONALE

Although pseudoaneurysm (PA) formation following primary and revision total hip arthroplasty (THA) is rare, PA rupture may lead to severe complications that can result in a threat to life and limb.

PATIENT CONCERNS

A 65-year-old man presented with acute hemorrhagic discharge for one day from the chronic hip sinus secondary to revision THA that had been performed 6 years ago, for which he had received multiple courses of debridement, antibiotics, and implant retention procedures owing to periprosthetic joint infection (PJI).

DIAGNOSES

Radiographs showed septic loosening of both the femoral and acetabular components, with medial migration of the component beyond Kohler's line. Contrast-enhanced computed tomography angiogram of the abdomen and pelvis of the patient demonstrated a large PA of the right external iliac artery (EIA), measuring 6.1 cm × 7.7 cm in diameter and 9.1 cm in length.

INTERVENTIONS

A ball-shaped antibiotic-loaded cement spacer (ALCS) was used to tamponade a bleeding PA, treat the coexisting PJI, and thus facilitate endovascular stent-graft repair (ESGR) later on.

OUTCOMES

The ESGR resulted in complete exclusion of the PA and successfully controlled the bleeding. The patient underwent a successful revision THA 6 months after stent insertion. Neither stent-graft infection nor recurrent PJI were detected at 18 months.

LESSONS

Given the potential of a PA for causing significant morbidity and mortality, the surgeon should have an elevated index of suspicion in the presence of intrapelvic migration of the acetabular component. While facing a PA rupture with/without hemorrhagic shock in patients with coexisting hip PJI, ALCS ball implantation and subsequent ESGR might be an effective method to save the patient's life and limb.