Iatrogenic popliteal artery injury in non arthroplasty knee surgery

Abstract

We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intra-operatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support.

Pseudoaneurysm Formatlion due to Popliteal Artery Injury Caused by Drilling during Medial Opening Wedge High Tibial Osteotomy

“…Injury of the popliteal and anterior tibial arteries is a rare complication of HTO 2 – 4) . In addition, most of the injuries of the popliteal and anterior tibial arteries occur during lateral close wedge HTO 2) .…”

“…In addition, most of the injuries of the popliteal and anterior tibial arteries occur during lateral close wedge HTO 2) . Several cases of vascular injuries were reported following MOWHTO, which was due to the use of an osteotome 3 , 4) or an oscillating saw for tibial osteotomy 5) . However, there has been no report of injury of the popliteal artery due to drilling during screw fixation of the locking plate after the osteotomy.…”

“…Therefore, it is advisable to decompress the tourniquet before wound closure to evaluate the amount of bleeding 3) . Bernhoff and Bjorck 4) analyzed 21 iatrogenic popliteal artery injuries during non-arthroplasty knee surgery. Nine injuries were detected intraoperatively, five within 12–48 hours and seven >48 hours postoperatively.…”

Arteriovenous Fistula Formation After Intra-articular Injection Following Total Joint Arthroplasty

“…7,8 Rapid identification and treatment of iatrogenic popliteal artery injury has been shown to lead to better outcomes compared with delayed identification or definitive repair, and more effective methods are needed to detect and treat these injuries. 9 Knee positioning was believed to be an effective method to avoid accidental injury to the popliteal artery. 10 However, studies that used magnetic resonance imaging and ultrasound to determine the position of the popliteal artery during TKA found no reliable safe position of the knee (extension or flexion) during the procedure.…”

Iatrogenic articular cartilage injury: the elephant in the operating theatre

“…In normally-aligned uninjured limbs, biological agents such as Salubrinal[ [19]] and Torin 1,[[20]] and even mRNA manipulation, may have a role in maintaining cartilage health, but these are still at an early stage of development. It is clearly essential for surgeons to prevent all avoidable iatrogenic injuries, which have been reported with a range of procedures,[ [21,22]] however, iACI is particularly insidious as it may not be immediately evident to the surgeon.…”