Tourniquet Failure during Total Knee Replacement Due to Arterial Calcification: Case Report and Review of the Literature

Barr, Lynne; Iyer, Uma Shridhar; Sardesai, Anand; Chitnavis, Jai

doi:10.1177/175045891002000202

Cited by 19 publications

(13 citation statements)

References 19 publications

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“…Conversely, case reports have shown that vascular calcification can decrease the effectiveness of the tourniquet secondary to noncompressible arteries. 15 However, in another study by the previous author, intimal calcifications, and specifically medial layer calcifications which are known to have increased arterial stiffness, were compared with a similar cohort without calcification. At 350 mm Hg, they showed no increased failure rate as measured by increased intraoperative blood loss between patients with arterial calcification and those without.…”

Section: Use In Patients With Vascular Diseasementioning

confidence: 99%

Tourniquet Use in Total Knee Arthroplasty

Arthur

Spangehl

2019

J Knee Surg

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In this prospective, randomized study of 80 patients, Abdel-Salem and Eyres reported significantly lower pain scores in the non-tourniquet group than in the tourniquet group using a linear analogue scale (mean pain score at 4 hours = 4 and 8, respectively, p<0.05). In addition, the authors identified more cases of wound infection and deepvein thrombosis in the tourniquet group.In this randomized radiosteriometric analysis (RSA) study of 50 patients, Ledin et al. found pain measurements using a visual analogue scale were lower in the nontourniquet group ( p=0.01) and range of motion was 11 degrees greater in the non-tourniquet group (p=0.001 at 2 years). In addition, RSA showed no significant differences in loosening at 6 months, 1 year, and 2 years.Effects of tourniquet during total knee arthroplasty. A prospective randomised study. Abdel-Salam A, Eyres KS. J Bone Joint Surg Br. 1995;77(2):250-253.

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Section: Use In Patients With Vascular Diseasementioning

confidence: 99%

Tourniquet Use in Total Knee Arthroplasty

Arthur

Spangehl

2019

J Knee Surg

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“…Tourniquet use is associated with risks such as neurological injury, rhabdomyolysis, and pulmonary embolism. 9 The use of a pneumatic cuff in calcified arteries may lead to other complications, such as ineffective arterial occlusion (continuous bleeding during surgery), rupture of the vessel wall, acute arterial occlusion, aneurysm formation, and displacement of an atheromatous plaque causing distal arterial occlusion. 9 The persistence of venous bleeding after the pneumatic cuff is inflated may be related to inadequate positioning at the upper end of the thigh, and cannot be attributed solely to the presence of arterial calcification.…”

Section: Discussionmentioning

confidence: 99%

“…A pneumatic cuff is routinely used during knee replacement surgery. The advantages of its use are promoting a cleaner operative field, lower perioperative bleeding, better quality of implant cementation, and faster surgery 9 ; it also decreases the surgeon's risk of acquiring diseases such as AIDS or hepatitis. However, its use has been associated with the incidence of neurapraxia, vascular injury, muscle damage, postoperative pain, cardiovascular alterations, and wound healing complications.…”

Section: Introductionmentioning

confidence: 99%

“…However, its use has been associated with the incidence of neurapraxia, vascular injury, muscle damage, postoperative pain, cardiovascular alterations, and wound healing complications. 9 …”

Section: Introductionmentioning

confidence: 99%

“…Calcium deposits in the intima layers of the arteries could lead to this alteration. 9 , 14 The artery is elastic and calcification can make the vessel less compliant and more vulnerable to acute occlusion or rupture of its wall. 9 , 13 , 15 , 16 , 17 …”

Section: Introductionmentioning

confidence: 99%

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The use of tourniquet during total knee replacement in patients with and without popliteal artery calcification

Vivacqua

Barroso

Matos

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveIdentify the clinical and surgical complications associated with the use of a tourniquet in total knee arthroplasty in patients with or without calcification of the popliteal artery.MethodsThe study was performed retrospectively, analyzing 58 patients with calcification of the popliteal artery and 57 patients as a control group.ResultsThe case group patients were significantly older than patients in the control group; however, this had no impact on the clinical outcome in the analyzed period.There were no complications during surgery in the groups studied, as there were no statistically significant differences between the incidence of local or systemic intercurrences in the analyzed period.ConclusionThis study found low rates of complications in patients undergoing total knee arthroplasties with use of a tourniquet, with or without calcification of the popliteal artery.

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Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft

Kim

Moon

2021

Microsurgery

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Background: With severe vascular calcifications, vascular clamp application and utilizing the vessel for free flap recipient vessel becomes impossible. These obstacles can be overcome with the Fogarty catheter and vein graft.Patients and methods: When unclampable artery was encountered intraoperatively, a vein graft was used to make a clampable recipient site for six diabetic foot patients (ages from 42 to 80). The end of the Fogarty catheter was inserted into the proximal end of the vein graft and the transected calcified vessel in sequence, and the balloon of the catheter was used as an intraluminal tourniquet. The remaining end of the vein graft was connected to the distal vessel with a vascular clamp.Results: Five short vein graft revascularization for segmental arterial occlusion, one long vein graft for recipient artery elongation was done (lengths from 2 to 13.8 cm).Three delayed, and two immediate anterolateral thigh flaps (sizes from 15 to 150 cm 2 ) were performed, and one patient received vein graft revascularization surgery only. Postoperative vascular sonography of all six patients showed wellmaintained patency. Minor flap marginal disruption occurred at two patients but healed with conservative care. Postoperative follow-up was done for 1-18 months (average 7.17). Limb salvage was achieved for five patients and all five free flaps survived. However, for one patient, arterial restenosis at popliteal artery a month later lead to major amputation. Conclusion:Using a Fogarty catheter and a vein graft may obtain perfect hemostasis during micro-anastomosis and achieve successful microvascular reconstruction in patients with severely calcified vessels.

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Tourniquet Failure during Total Knee Replacement Due to Arterial Calcification: Case Report and Review of the Literature

Cited by 19 publications

References 19 publications

Tourniquet Use in Total Knee Arthroplasty

Tourniquet Use in Total Knee Arthroplasty

The use of tourniquet during total knee replacement in patients with and without popliteal artery calcification

Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft

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