Abstract:The anatomy suggests the aberrant anterior tibial artery may be at greater risk of injury in orthopaedic procedures such as high tibial osteotomy, revision total knee arthroplasty, lateral meniscal repair, posterior cruciate ligament reconstruction, and screw fixation for tibial tubercle osteotomy. Careful inspection of preoperative magnetic resonance imaging studies may alert the surgeon to the presence of this anatomical variant.
“…Surgical repair is technically challenging, as it is affected by the degree of injury, anatomic distortion around the lesion, excessive bleeding, and has an increased risk of iatrogenic nerve injury (2223). Anatomic variations of the popliteal artery often lead to more difficult surgical reconstruction procedures with increased risk of iatrogenic vascular injury (2425). …”
ObjectiveTo evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries.Materials and MethodsA retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries.ResultsTechnical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up.ConclusionEndovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.
“…Surgical repair is technically challenging, as it is affected by the degree of injury, anatomic distortion around the lesion, excessive bleeding, and has an increased risk of iatrogenic nerve injury (2223). Anatomic variations of the popliteal artery often lead to more difficult surgical reconstruction procedures with increased risk of iatrogenic vascular injury (2425). …”
ObjectiveTo evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries.Materials and MethodsA retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries.ResultsTechnical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up.ConclusionEndovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.
“…In a study by Klecker et al. [4], the incidence of a high-division ATA was 2.1%. In such cases, the risk of vascular trauma may increase during proximal tibial resection in TKA.Fig.…”
Section: Discussionmentioning
confidence: 99%
“…Angiography can show the exact location of the pseudoaneurysm and vascular malformation, and it can be used for therapeutic purposes by stopping the bleeding once discovered [17]. Computed tomography and magnetic resonance angiography are not usually considered for diagnosis of artifacts caused by the prostheses, while magnetic resonance imaging can be used to identify an aberrant ATA preoperatively [4]. …”
Section: Discussionmentioning
confidence: 99%
“…The anterior tibial artery (ATA) is a terminal branch of the popliteal artery and usually divides below the articular surface of the tibial plateau. The presence of a high-division ATA may increase the risk of intraoperative vascular injury [4]. Herein, the authors report the case of a pseudoaneurysm arising from a high-division ATA during primary TKA that was successfully treated with endovascular embolization without long-term complications.…”
Arterial complications following total knee arthroplasty are rare but carry a high risk of significant morbidity and mortality. Herein, the authors report a case of pseudoaneurysm in a branch of a high-division anterior tibial artery caused by laceration by the retractor following primary total knee arthroplasty in a 72-year-old woman. The patient presented with an unexplained hematoma and an enlarging swelling, with pallor and acute hemorrhage on the first postoperative day. The diagnosis was confirmed by arteriography and the patient was successfully treated using endovascular embolization without long-term complications. Because of the high risk of progression to a potentially limb- or life-threatening condition, it is important to discuss the risk factors for this complication, as well as its early diagnosis and treatment methods.Electronic supplementary materialThe online version of this article (doi:
10.1007/s00132-016-3373-3) contains two videos on diagnosis and treatment of the pseudoaneurysm. The article and the supplementary material are available in the electronic archive at http://www.springermedizin.de/der-orthopaede.
“…[12][13][14][15][16][17][18] There is also an inherent risk of neurovascular injury. [19][20][21][22][23] Thus there is room for innovation to improve healing rates, enable repair of nonvertical tear patterns, and decrease or eliminate risk to neurovascular structures.…”
Over the past 30 years, many patients have benefited from arthroscopically assisted meniscus repair surgery and its ability to preserve a healthy knee. Although techniques have evolved, the basic premise of central-to-peripheral needle penetration across the tear with fixation into the capsular region immediately peripheral to the meniscus has remained. Suture repair techniques that involve encircling the tear have been discussed but have remained largely impractical because of the anatomic constraints of the arthroscopic knee. A suture-passing technology designed to function within these constraints was recently made available from Ceterix Orthopaedics (Menlo Park, CA). It allows surgeons to arthroscopically place circumferential sutures around meniscus tears to provide uniform, anatomic compression of the tear edges through an all-inside technique. This stitch is likely to improve healing rates and safety, as well as to enable repair of tears that were previously considered difficult or impossible to sew. The purposes of this note and accompanying video are to show the feasibility of placing all-inside circumferential compression stitches to treat tears of the knee meniscus and to discuss the potential benefits of such techniques.
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