The management of vascular injuries associated with total hip arthroplasty

Abstract

Approximately 100,000 total hip reconstructions are done annually in the United States. The nature of the surgical technique in a field close to the iliac and femoral vessels makes the occurrence of vascular injury an occasional but serious complications. We have reviewed retrospectively our experience of five cases of vascular injuries with total hip replacement and an additional 63 cases in the literature to identify those patients at risk and to define the management of these injuries. For the entire group of 68 patients, most injuries were sustained on the left side (66%), and 39% were seen in revisions. Complications were related to cement incorporation of the iliac vessels (44%), aggressive medial retraction (17%), excessive traction on atherosclerotic vessels (10%), and improper technique in preparation of the acetabulum. The most commonly injured vessels were the external iliac artery (36), common femoral artery (17), and external iliac vein (6). Twenty-seven of these injuries required emergent surgery, most for hemorrhage (66%). Injuries consisted of thromboembolic complications leading to distal ischemia (46%), vessel lacerations (26%), pseudoaneurysms (25%), and arteriovenous fistulas (3%). Vascular repair was individualized and included suture repair, thrombectomy and patch angioplasty, embolectomy, and arterial and venous bypass procedures. There was an overall 7% mortality and a 15% incidence of limb loss. Risk factors include (1) revision procedures, (2) left-sided procedures, and (3) intrapelvic migration of the acetabular component of the hip prosthesis. Elective vascular workup and preliminary retroperitoneal exposure of the iliac vessels at time of hip arthroplasty is recommended for patients at risk.

Risk of vascular and neurological complications during acetabular implantation in total hip replacement surgery

“…Az érsérülések 7%-a fatális kimenetelű, 15%-a amputációval végző-dik. 3 Kiemelkedő az a. és a v. iliaca externa sérülésének magas gyakorisága. Shoenfeld 3 tanulmányában 68 érsérülésből 36 (48%) érin-tette az iliacalis képleteket.…”

“…Ezt részben magyarázhatja, hogy a diszplázia, illetve a kilazult vápa migrációja miatt a képletek lokalizációja a megszokott anatómiai helyzethez képest megváltozik. 3 A korábbi műtéti beavatkozások által okozott hegesedés, az erek, idegek lehorgonyzódása is fokozza a sérülés veszélyét. 8 Operált betegeknél fennállhat a kollaterális keringés meglévő károsodása, amely egy esetleg bekövetkező nagy érsérülésnél végzetes következmények-kel járhat.…”

“…8 Operált betegeknél fennállhat a kollaterális keringés meglévő károsodása, amely egy esetleg bekövetkező nagy érsérülésnél végzetes következmények-kel járhat. 3,12 …”

Acute occlusion of aortobifemoral bypass graft after revision total hip arthroplasty

“…Thromboembolic complications appear to be the most common type of vascular insult in THA accounting for nearly 50%. The external iliac vessels have the highest incidence of involvement [20]. It is uncommon to involve the iliofemoral artery or superficial femoral artery [14,21].…”

Acute Iliac and Femoral Arterial Thrombosis Secondary to Total Hip Arthroplasty

“…Approximately 100,000 total hip reconstructions are done annually in the United States [1]. Although they are rare, vascular injuries happen with total hip arthroplasty (THA) [2].…”