Popliteal A-V Fistula with Pseudo-aneurysm: A Complication Following Total Knee Arthroplasty

Pydisetty, Ravikumar V.; Gillies, Robert M.

doi:10.1007/s00068-008-7119-8

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…Diagnostic investigations included ABI, Doppler/duplex studies, and angiograms [12, 25, 36]. Treatments included observation, direct repair, angioplasty, stenting/bypass, thrombectomy, endarterectomy, coil embolization, ultrasound compression, fistula resection, and amputation [4, 12, 14, 18, 22, 25, 42]. Outcomes ranged from complete resolution of symptoms to amputation and mortality [4, 36, 46].…”

Section: Discussionmentioning

confidence: 99%

Delayed Arterial Occlusion Presenting as Foot Drop Following Primary Total Knee Arthroplasty in a Varus Knee: A Case Report and Review of the Literature

Prince¹,

Matthews²,

Phillips³

2021

Case Rep Orthop Res

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We present a 69-year-old male with osteoarthritis of a varus mechanically aligned left knee that developed delayed arterial thrombosis after primary total knee arthroplasty (TKA) requiring stenting and subsequent trans-metatarsal amputation. This case is unique since initial presentation involved neurologic instead of ischemic changes. We also performed a literature review of arterial injuries in primary TKA. This case highlights the importance of maintaining a high clinical suspicion for vascular insult in patients undergoing correction of varus malalignment with initial complaints of neurologic dysfunction.

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Section: Discussionmentioning

confidence: 99%

Delayed Arterial Occlusion Presenting as Foot Drop Following Primary Total Knee Arthroplasty in a Varus Knee: A Case Report and Review of the Literature

Prince¹,

Matthews²,

Phillips³

2021

Case Rep Orthop Res

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Vascular Injuries in Total Knee Arthroplasty

et al. 2020

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Background: Vascular injuries associated with total knee arthroplasty can have limb and life-threatening consequences. The aims of this study were to conduct a meta-analysis of the overall rate of vascular injuries after total knee arthroplasty and to conduct a systematic review of specific major and minor vessel injuries. Methods: All English-language literature published from January 1, 1998, to November 30, 2018, was queried in 4 unique databases using a common search term. This yielded 404 results, of which 270 were unique. Two reviewers then assessed studies for eligibility. All non-human studies, cadaver studies, studies describing only human images, and human studies with non-acute pathology were excluded. The final study included 10 large epidemiological studies and 68 case series or studies. Data from the literature were abstracted into a comma-separated database spreadsheet using Microsoft Excel. A meta-analysis was then performed. Pooled statistics were calculated with weighting by inverse variance assuming a random effect model. I2 was calculated as a quantifier of heterogeneity and interpreted according to the Cochrane manual. All data analysis was performed using R software. Results: Among the 1,419,557 total knee arthroplasties reported in 10 studies, there were 767 major vascular injuries (0.05% [54 per 100,000 total knee arthroplasties]). Amputation or long-term neurological complications occurred in approximately 21% of patients after major vascular injury. Presentation after 24 hours occurred in 36% of cases. The most frequently injured vessels were the geniculate arteries, popliteal artery, superficial femoral artery, and anterior tibial artery. The injuries that were most likely to result in amputation were femoral artery occlusion, popliteal artery transection, and popliteal artery arteriovenous fistula. Conclusions: Amputation and long-term neurological complications are common complications after a vascular injury associated with a total knee arthroplasty. Preoperative consultation with vascular surgery physicians may be a prudent approach before a surgical procedure for patients with known peripheral vascular disease, diabetes, hypertension, or smoking; however, more data on risk factors are needed. Awareness by the surgical team and implementation of specific strategies during a surgical procedure such as gentle manipulation of the knee and careful retraction may further reduce the rate of injuries. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Popliteal Arteriovenous Fistula Diagnosed Eight Years after Total Knee Arthroplasty. Endovascular Treatment with Viabahn® Endoprosthesis and Five-Year Follow-Up

Lozano-Sánchez,

García-Alonso,

Salvador-Calvo

et al. 2024

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Background: Orthopedic surgery, while it rarely cause iatrogenic vascular lesions, leads to significant clinical, social, and economic consequences when it does. The knee is particularly susceptible to these injuries. Case Description: This case study presents the clinical case of a 71-year-old woman with a history of left total knee replacement. Eight years after the initial procedure, a popliteal—popliteal arteriovenous fistula was identified in the same knee. Given the location and caliber of the fistula, and despite the absence of symptoms, an endovascular prosthesis (Viabahn®) was deployed in the popliteal artery to cover the fistula. The prosthesis remained intact for the remainder of the patient’s life, who succumbed to metastatic cancer five years later. Additionally, a review of the literature was conducted. Conclusion: This brief report describes an exceptional case of popliteal arteriovenous fistula, diagnosed eight years after a TKA, treated endovascularly and followed up over five years. Both pseudoaneurysms and arteriovenous fistulae should also be considered for early detection.

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Popliteal A-V Fistula with Pseudo-aneurysm: A Complication Following Total Knee Arthroplasty

Cited by 3 publications

References 10 publications

Delayed Arterial Occlusion Presenting as Foot Drop Following Primary Total Knee Arthroplasty in a Varus Knee: A Case Report and Review of the Literature

Delayed Arterial Occlusion Presenting as Foot Drop Following Primary Total Knee Arthroplasty in a Varus Knee: A Case Report and Review of the Literature

Vascular Injuries in Total Knee Arthroplasty

Popliteal Arteriovenous Fistula Diagnosed Eight Years after Total Knee Arthroplasty. Endovascular Treatment with Viabahn® Endoprosthesis and Five-Year Follow-Up

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