Vascular complications in orthopaedic surgery

Abstract

Vascular complications during orthopaedic surgery, although rare, do occur. Most vascular complications occur intraoperatively, immediately postoperatively or in the late postoperative period; they most commonly include lacerations, pseudoaneurysms, thrombosis, and arteriovenous fistulas. The operations most commonly associated with vascular injuries are knee arthroplasty, followed by hip arthroplasty, spinal surgery, and knee arthroscopy. Most commonly the popliteal artery is involved, followed by the tibial, superficial femoral, iliac, common and profunda femoral arteries. Color Doppler ultrasound is the initial imaging method used to evaluate a vascular injury. Computed tomography and magnetic resonance angiography are usually not applicable in joint replacement surgery because of the artifacts caused by the prostheses. When noninvasive imaging fails to reveal the injury, angiography is required. Traditional management of vascular surgical complications have included vascular surgical intervention. However, the availability of a vascular surgical team is required, and re-exploration of the operative site to treat acute ischemic complications of joint replacement may be difficult and may fail because the source of bleeding is not always apparent. In this setting, endovascular treatments such as balloon arterial thrombectomy, balloon angioplasty with and without stenting, and transcatheteral selective arterial embolization have been effective, successful, and safe interventional techniques in the acute or late postoperative period after elective orthopedic surgery. These techniques should be considered as the first option in the treatment of these lesions.

Pseudoaneurysm of a high-division anterior tibial artery following primary TKA

“…Patients with a history of peripheral arterial disease may also have a high risk of arterial complications [3]. The risk of arterial injury after revision TKA is twice that after a primary procedure because blood vessels may be encased by fibrous scar tissue, rendering them more vulnerable to indirect or direct injury [8, 16]. Other risk factors include weight loss, renal failure, coagulopathy, and metastatic cancer [6].…”

Relationship Between the Middle Genicular Artery and the Posterior Structures of the Knee

“…Common injuries are laceration, pseudoaneurysm, thrombosis, and arteriovenous fistulas secondary to iatrogenic trauma from inappropriately placed retractors or direct vascular injury (cut by sharp instruments, vessel avulsion, thermal injury, plunging drill bits), anomalous anatomy and scar tissue due to previous surgery, malpositioned implants and fixation devices, periarticular calcification, or ossification. 36 The MGA can be placed at risk during open posterior knee surgery (open reduction internal fixation [ORIF] medial plateau fractures, ORIF PCL avulsion fracture fixation, cyst/tumor removal, PCL reconstruction, posterior synovectomy) due to iatrogenic trauma from inappropriately placed retractors or direct vascular injury (sharp instruments, vessel fragility, thermal injury, plunging drill bits). In cases of unrecognized or iatrogenic MGA damage in open surgery, the lack of ligation of the MGA can be associated with an increase of morbidity due to ischemic events, thromboembolic problems, and a negative impact on the functional outcome due to soft tissue disturbance caused by blood extravasation.…”

Assessment and management of chronic pain in patients with stable total hip arthroplasty

“…This may occur through direct violation of the vessels or by intraoperative traction on the leg (stretching of the vessels) when there is a pre-existing vascular stenosis. In addition, displacements of the vessels or injuries caused by scar contraction or other aetiologies can result in the formation of arteriovenous fistulas and aneurysms [69][70][71]. In these cases, the diagnosis can be confirmed with the assistance of Doppler ultrasonography or angiography in addition to clinical examination.…”

“…These patients can present with a palpable groin mass, a bruit may be heard on a stethoscope, and there may be a sudden drop in the patient's haematocrit. Treatments include consultation with a vascular team and either open bypass or endovascular coiling of the fistula or aneurysm [69][70][71][72].…”