Therapeutic embolisation for postoperative haemorrhage after total arthroplasty of the hip and knee

Abstract

We describe three cases of postoperative haemorrhage, two after total hip and one after total knee replacement, treated by percutaneous embolisation. After diagnostic angiography, this is the preferred method for the treatment of postoperative haemorrhage due to the formation of a false aneurysm, after hip or knee arthroplasty. This procedure, carried out under local anaesthesia, has a low rate of complications and avoids the uncertainty of further surgical exploration.

Successful treatment of severe bleeding in hemophilic target joints by selective angiographic embolization

“…9 Even more, there are only a few reports on therapeutic embolization for postoperative bleeding after total arthroplasty of knee or hip joints in patients without hemophilia. 10,11 However embolization for other medical indications is not uncommon. For many years this procedure has been used successfully in treating patients without hemophilia, for ruptured intracranial aneurysms, obstetric hemorrhages, massive hemoptysis, or other types of massive bleeding and preoperatively in patients with well-vascularized tumors.…”

Case report: Delayed spontaneous retroperitoneal haematoma after unilateral total hip replacement

“…), damage with the heat produced during the polymerisation of the polimethylmethacrylate and the creation of a false aneurism or arteriovenous fistula induced by repeated local trauma [3]. Retroperitoneal haematoma is a rare entity [6].…”

“…Apart from delineating any ruptured vessels, it allows for selective arterial embolization during the same procedure. Embolization reduces the risk of complications such ischemia of surrounding structures [3].…”

Embolisation for Vascular Injuries Complicating Elective Orthopaedic Surgery

“…30e32 Embolisation of non-targeted vessels can result in a large zone of tissue necrosis and may be associated with nerve palsy and long-term functional deficits, skin breakdown, muscle necrosis, infection or limb loss. 18e20, 24,25 Care should be taken regarding the location and vascular supply of at-risk vital structures, such as the femoral region, to avoid embolising supply to the sciatic nerve. 30e32 The Adamkiewicz artery that originates between the T5 and L2 vertebrae should be recognised on the pre-embolisation angiography.…”