Therapeutic embolisation for postoperative haemorrhage after total arthroplasty of the hip and knee

Abstract

We describe three cases of postoperative haemorrhage, two after total hip and one after total knee replacement, treated by percutaneous embolisation. After diagnostic angiography, this is the preferred method for the treatment of postoperative haemorrhage due to the formation of a false aneurysm, after hip or knee arthroplasty. This procedure, carried out under local anaesthesia, has a low rate of complications and avoids the uncertainty of further surgical exploration.

A bleeding pseudoaneurysm of the lateral genicular artery after total knee arthroplasty—A case report

“…The literature on angiography and embolization for the diagnosis and treatment of hemarthrosis after total knee arthroplasty is also anecdotal (Noorpuri et al 1999, Barriga et al 2001, Katsimihas et al 2001, Pritsch et al 2003. In all the cases reported, as in our case, it turned out to be an excellent diagnostic and therapeutic tool.…”

“…There are few reports in the English-based literature which describe bleeding from a false aneurysm of a genicular artery after total knee replacement surgery (Noorpuri et al 1999, Pai 1999, Barriga et al 2001, Moran et al 2002. The possible mechanisms of vascular injury during total knee arthroplasty are: 1. perforation by a retractor, 2. injury to an atherosclerotic artery, 3. tourniquet injury, 4. direct trauma to a vessel, 5. vascular injury secondary to the heat of the cement, and 6. vascular injury due to repeated local trauma (Langkamer 2001).…”

Endovascular Treatment in Emergency Setting of Acute Arterial Injuries After Orthopedic Surgery

“…In the literature, TAE for iatrogenic orthopedic injury has been reported in some case reports [8,23] and a few series [3,15]. As described previously [5,6,8,12], the coaxial technique with microcatheter and microcoil systems allows precise localization and catheterization of the bleeding arterial branches with minimal tissue compromise [24]. Accordingly, most of the tissue loss is limited to that caused by iatrogenic vascular injury itself.…”

“…TAE, performed as selectively as possible, may improve the chances of success and decrease the risk of complications, such as ischemia of neighboring structures, because it seems to be less invasive compared with a surgical approach [12]. In the literature, TAE for iatrogenic orthopedic injury has been reported in some case reports [8,23] and a few series [3,15].…”

“…In several cases, they may be devastating and lead to complications related to difficult control of bleeding, inability to maintain satisfactory haematocrit levels, and development of coagulation defects [4][5][6][7][8]. Serious vascular injuries after orthopedic procedures can also be effectively treated by minimally invasive angiographic procedures, which are considered the first line of therapy in a growing number of patient populations [4][5][6][7][8][9][10][11][12].…”