Total hip revision arthroplasty of high-risk pelvic vascular injury associated with an endovascular approach: a case report

Tavares, Rafael Leite de Pinho; Neto, Elias Arcenio; Taki, Walter

doi:10.1016/j.rboe.2018.07.002

Cited by 4 publications

(6 citation statements)

References 15 publications

(19 reference statements)

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“…9,13,14 On the other hand, preventive stenting was rarely reported in series or case reports. 7 In 2016, we began a pilot project with the main purpose of avoiding or diminishing the risk of vascular injury during revision THA. In our first two cases, immediately before the orthopaedic surgery, a sheath and guidewire were inserted in the vessel at risk.…”

Section: Discussionmentioning

confidence: 99%

Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

et al. 2022

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Aims Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients. Cite this article: Bone Jt Open 2022;3(11):859–866.

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Section: Discussionmentioning

confidence: 99%

Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

et al. 2022

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“…have previously established that the posterior quadrants are relatively safe when compared to the anterior quadrants where the external iliac and obturator neurovascular bundle are at risk in the superior and inferior quadrants, respectively [ 8 , 17 , 28 , 29 ]. Injury to these vessels, particularly the external iliac, are known to occur [ 7 , 9 , 11 , 17 , 20 , 21 , [30] , [31] , [32] , [33] , [34] , [35] , [36] ]. Other authors have characterized the distance to danger from the acetabular surface, and in the anterior acetabulum, this distance is nearly universally <20 mm [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…The placement of transacetabular screws is recognized to have associated risk, and close attention must be paid to the extrapelvic acetabular quadrant in which these are placed [ [6] , [7] , [8] , [9] ]. A multitude of complications have been reported with aberrant screw placement including arterial laceration, [ 10 ] arterial pseudoaneurysm formation, [ [11] , [12] , [13] , [14] ] bladder injury, [ 15 ] and nerve irritation, [ 16 ] among others [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

Wilson¹,

Pflederer²,

Schwartz³

et al. 2021

Arthroplasty Today

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Background Intraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic screw penetration. Methods A radiopaque pelvis Sawbones model was instrumented with a hemispherical acetabular component. Four intrapelvic quadrants were defined. Screws were placed, 3 in each quadrant, and imaged sequentially at 3 depths: 0 mm, 5 mm, and 10 mm penetrated. Eight fluoroscopic images were used: anteroposterior, inlet, outlet, iliac oblique, obturator oblique, “down the wing,” obturator outlet, and a “quad” view. Three blinded, independent surgeons evaluated the images for intrapelvic screw penetration. Images were analyzed in isolation and as a “triple-shot series” consisting of the “quad,” obturator outlet, and iliac oblique views. Sensitivity and specificity values were then calculated. Results In isolation, the “quad” view had the highest sensitivity for screw penetration (62%). The triple-shot series was found to be 100% sensitive in all 4 quadrants for detecting 10 mm of screw penetration. The specificity of the series was found to be 100% in all quadrants except for the posterior superior quadrant where it was 67%. Interobserver agreement approached perfection (Kappa ≥0.947) between all surgeons ( P < .001) when using the 3-view series. Conclusions This study is the first to assess the use of fluoroscopy in the detection of intrapelvic penetration of transacetabular screws. We found that a 3-radiograph series provided a sensitive and specific metric for the detection of intrapelvic screw penetration.

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“…One such risk factor is transacetabular screw placement [17]. It has long been recognized that placement of transacetabular screws must be done with caution and that attention must be paid to the acetabular quadrant in which these are placed [18], [19], [20], [21]. Here, we report a case of symptomatic external iliac artery (EIA) PSA formation secondary to a transacetabular screw with medial wall penetration.…”

Section: Introductionmentioning

confidence: 95%

External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation

et al. 2019

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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.

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Total hip revision arthroplasty of high-risk pelvic vascular injury associated with an endovascular approach: a case report

Cited by 4 publications

References 15 publications

Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation

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