Acute Arterial Occlusion Following Primary Total Knee Arthroplasty

Abstract

Acute arterial occlusion is a rare complication following total knee arthroplasty (TKA). This is a report of a case of acute femoral artery occlusion and its sequelae following TKA in a patient with a history of atrial fibrillation. Arterial circulation of the lower limb could not be restored by thrombectomy treatments, and above-knee amputation had to be carried out.

Superficial femoral artery pseudoaneurysm, compartment syndrome, and deep vein thrombosis after total knee arthroplasty

“…Most complications in TKA are diagnosed in the first 24 to 48 hours, allowing for early treatment and avoiding the need of amputation, contrary to what happened in our case [2][3][4][5]7,8,10,11,15,16]. Nonetheless, despite optimal management of complications following early diagnosis, there can be loss of functionality, such as foot drop and articular rigidity, or requirement of external aids for mobility, and the quality of life of patients can get compromised [6,7,9,17].…”

“…Surgical procedures in the series reported are more frequently described in the popliteal artery [3][4][5]10]. There are also reports on the use of tourniquet producing proximal artery injury, especially in the femoral artery [4,11], as well as on adductor canal blockage with posterior hematomas and pseudoaneurysms during endovascular procedures [12][13][14]. Literature has also reported cases in which an etiology has not been found [4,6,15].…”

“…Although clinical suspicion is based on an adequate physical examination and is the first step for treatment, the use of diagnostic aids is fundamental to identify and recognize the degree of vascular compromise [5,[8][9][10][11]18].…”

“…Reported incidence on popliteal vascular injury in some studies ranges between 0.003% and 0.19% [19][20][21][22]. Nevertheless, the incidence of vascular injuries different from popliteal artery is not clear despite available literature on vascular injury at different levels (either proximal and distal femoral and anterior tibial arteries) [4,5,[11][12][13][14][15]20,23]. Apart from this, anesthetic or analgesic procedures have also been reported as causative for vascular injury [14].…”

The prevalence of arterial and venous abnormalities in asymptomatic patients undergoing total knee arthroplasty

“…Acute popliteal artery occlusion from arterial complications is rarely reported in the literature and has often been reported as case reports. [15,16] In patients with atherosclerosis, the acute rupture of atheroma plaque is the main cause and has been reported as 0.03 to 0.17%. [16] Preliminary diagnosis of risky patients is critical to identify the urgent need for intervention after or during TKA.…”