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

Endovascular Treatment for Isolated Infected Iliac Artery Aneurysms

PURPOSE

Isolated infected iliac artery aneurysms (IIIAAs) are extremely rare, life-threatening, and intractable. This study aimed to evaluate the outcomes of endovascular treatment in patients with IIIAAs.

METHODS

A retrospective study was conducted for all patients who underwent endovascular treatment for IIIAAs between June 2012 and June 2022 in 3 hospitals. The clinical data and follow-up outcomes were reviewed and assessed.

RESULTS

Fifteen patients were included in this study. The median age was 69 years, 12 patients (80%) were men, and 8 (53%) had hypertension. Most of the patients presented with abdominal or lumbar pain (87%) and fever (60%). The offending pathogen was identified in 11 patients (73%). Fifteen patients had a total of 16 IIIAAs, with 12 (75%) involving the common iliac artery. The immediate technical success rate was 100%, and the 30-day mortality was 7%. Infection-related complications occurred in 2 patients (13%) during hospitalization who were treated by open surgery at a later stage. The median follow-up was 23 months (range: 6-80 months, mean: 32 ± 25 months). Aneurysm recurrence was identified in one patient (7%) 5 months after endovascular repair. It was managed by endovascular stent-graft repair with percutaneous catheter drainage. No patients died during the follow-up period.

CONCLUSION

Endovascular treatment is feasible, safe, and effective for patients with IIIAAs, achieving acceptable clinical outcomes. Infection surveillance with essential reintervention should be considered for potential infection-related complications.

CLINICAL IMPACT

This study first reported that 15 patients underwent endovascular treatment for primary isolated infected iliac artery aneurysms (IIIAAs). It showed a good early and midterm outcomes. This is the first and largest multi-center study and the first literature review of IIIAAs. It provides an evidence that endovascular treatment is feasible, safe, and effective to treat IIIAAs. It suggests endovascular treatment is a promising alternative or a bridge to conventional open surgery for IIIAAs. This may promote endovascular therapy in the management of IIIAAs. It would help clinicians to make an appropriate treatment choice for IIIAAs.

Prophylactic placement of external iliac artery balloon catheter in a patient with intrapelvic prosthesis migration after hemiarthroplasty: A case report

Intrapelvic prosthesis migration is a rare but serious complication of bipolar hemiarthroplasty in femoral neck fractures. The external iliac artery is one of the most frequently damaged arteries during the removal of a migrated implant from the pelvic region. This report describes a case in which prophylactic placement of an external iliac artery balloon catheter was performed to reduce blood loss in the event of vascular injury during implant removal surgery in the pelvic region.

Effect of continuous nursing combined with salcatonin on postoperative pains in elderly patients after hip replacement

OBJECTIVE

This study was designed to explore the effect of continuous nursing combined with salcatonin on the improvements of postoperative pain in elderly patients after hip replacement.

METHODS

A total of 99 elderly patients treated by hip replacement in our hospital were divided into the control group (CG, n=49, routine nursing + salcatonin) and the study group (SG, n=50, continuous nursing + salcatonin). The visual analogue scale (VAS) during rest (RVAS), VAS during initiative movement (IVAS) and VAS during passive movement = (PVAS) at 3 d, 7 d, 10 d, 14 d and 30 d after operation, the Harris hip score (HHS), Barthel index and geriatric depression scale (GDS) at 1 month after operation, and the incidences of tumble and refracture during the postoperative 6-month follow-up were compared between the two groups.

RESULTS

In comparison with the CG, except for higher HHS and Barthel index at 1 month after operation (P<0.05), the SG was associated with lower RVAS, IVAS and PVAS at 7 d, 10 d, 14 d and 30 d after operation (P<0.05), lower GDS at 1 month after operation, and lower incidences of tumble and refracture during the 6 months after operation (P<0.05).

CONCLUSION

The combination of continuous nursing and salcatonin has achieved marked effects not only on mitigating the pains at the early stage after a hip replacement in elderly patients, but also on improving their joint functions and reducing the incidences of tumble and refracture in a long run.

Effect of predictive nursing on postoperative rehabilitation and complications of patients undergoing hip replacement and maintenance hemodialysis

OBJECTIVE

To analyze the effect of predictive nursing on postoperative rehabilitation index and complications in patients after hip replacement with maintenance hemodialysis.

METHODS

A total of 81 cases of patients underwent hip replacement and maintenance hemodialysis in our hospital were selected as the research objects and divided into study group (n=41) and control group (n=40) with retrospective analysis method based on different intervention method. Patients in the study group received predictive nursing, while patients in the control group received routine nursing. The hip function and activity, duration of walking with and without crutches, adverse emotions, pain and the incidence of various complications after intervention were compared between the two groups.

RESULTS

There was no significant difference in Harris score between the two groups at 7 days after intervention (P>0.05); the Harris scores of the study group were significantly higher than those of the control group (P<0.05) at 1, 3 and 6 months after intervention. Before intervention, there was no significant difference in hip activity between the two groups (P>0.05); 3 months surgery operation, the hip extension, abduction and rotation angle of the study group were significantly higher than those of the control group (P<0.05); the duration of walking with and without crutches in the study group were significantly shorter than those in the control group (P<0.05); the scores of adverse emotions, pain and complications in the study group were significantly lower than those in the control group (P<0.05).

CONCLUSION

The implementation of predictive nursing to patients underwent hip replacement and maintenance hemodialysis can improve hip activity and joint function after surgery, accelerate postoperative recovery, relieve postoperative pain symptoms, and reduce the incidence of various complications.

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.