Anticoagulation Therapy for Postoperative Deep Vein Thrombosis Coupled with Pulmonary Embolism: A Potential Trigger for Delayed Popliteal Artery Injury Presentation after Total Knee Arthroplasty

Endovascular Repair Of Popliteal Artery Injury Post-Total Knee Arthroplasty is Safe and Effective: A Case Report And Systematic Review Of the Literature

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.

Development of Vaginal Pseudoaneurysm 3 Years after Cesarean Section Possibly Induced by Anticoagulant and Antiplatelet Therapies

Pseudoaneurysms generally develop when an arterial puncture site is inadequately sealed. We encountered a case of vaginal pseudoaneurysm that developed 3 years after cesarean section in a 35-year-old gravida 7 para 4 woman who was prescribed with anticoagulant and antiplatelet drugs after surgeries for ventricular septal defect and aortic valve replacement. Pelvic computed tomography scan revealed a large mass, which showed a dappled contrast filling on the arterial phase, located in the posterior vaginal wall. The vaginal pseudoaneurysm was completely occluded by embolization of the left vaginal artery. Anticoagulation and antiplatelet therapies can be potential causes of spontaneous pseudoaneurysm rupture. Extrauterine pseudoaneurysm has a long period of time between cesarean section and pseudoaneurysm discovery. Considering that pseudoaneurysm shows different clinical features for each patient, we should always consider pseudoaneurysm when we assess a patient with postpartum hemorrhage.

Acute arterial occlusion after total knee arthroplasty: a case report

Popliteal artery occlusion after total knee arthroplasty is rare (0.03–0.17%) but can lead to amputation if overlooked. We should carefully assess vascular patency by Doppler ultrasound and ankle brachial pressure index (ABPI) measurement before and after total knee arthroplasty (TKA) operation.

Pulmonary embolism after a single-stage, combined anterior and posterior approach lumbar surgery

Pulmonary embolism is a fatal complication in orthopaedics surgery. While, the incidence of this life-threatening condition is low in spine surgery and few detailed reports have been published in English literatures. We present a case of pulmonary embolism which occurred after a single-stage, combined anterior and posterior approach surgery for L2 burst fracture. Although positive and timely rescue measures were performed, the patient died finally. We report the case to help spine surgeons to be aware of and take precautions against the fatal condition in spine surgery.