Life saving surgery for ruptured pseudo aneurysm of external iliac artery: case report

Abstract

The incidence of pseudo aneurysm after total hip arthroplasty is extremely rare. The most common mechanism of vascular injury is due to direct trauma during the operative procedure, and the most reported cases are acute in presentation. We reported an unusual case of ruptured pseudo aneurysm and control of life-threatening intra-operative hemorrhage of the external iliac artery in a male patient, 68 years old, with displaced total hip arthroplasty (THA), planned for removal, occurring 2 years after the last hip surgery, in Armed Forces hospital, Southern region, Saudi Arabia. This case highlights the importance of prompt recognition of life-threatening intra-operative hemorrhage to save the patient's life and the limb.

Profunda Femoris Pseudoaneurysm following Total Hip Arthroplasty Revision

“…Profunda femoris pseudoaneurysms have been previously reported in femoral shaft fractures [ 4 , 12 , 13 ] and hip core decompression [ 14 ], with slightly more prevalence than THA. The more common arteries injured during total hip arthroplasty include external iliac, common femoral, and femoral circumflex arteries [ 4 , 15 , 16 ]. Causes of PFA lesions in other studies were suspected to be from an avulsion injury likely during manipulation [ 17 ], injury during placement of hardware for a DHS [ 4 ], and violation during drilling for placement of an intramedullary nail [ 13 ].…”

“…Cases reported presentation of pseudoaneurysm at the time of revision surgery for various reasons [ 17 , 18 ], including pain [ 18 ], swelling [ 4 ], bleeding [ 5 , 14 , 16 ], vascular insufficiency [ 4 ], and chronically draining sinus development [ 4 , 16 ]. Previous studies have reported unresolving pain following surgery in the presentation of pseudoaneurysms in other locations [ 4 , 12 , 13 , 15 ].…”

“…This has been proposed as one of the possible causes of the patient's pain at initial presentation. Average detection time in these patients ranged from 4 months to 6 years after index procedure [ 4 , 15 , 16 ]. Further need for transfusions postoperatively was cited as the presenting or primary complaint in previous case reports [ 12 , 14 , 17 ].…”

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

“…The literature presents several reports of successful surgical treatment of vascular injuries, but with high morbimortality, especially in cases of acute intraoperative bleeding. 10 , 11 …”