Transarterial embolization of large complex arteriovenous fistula associated with hip joint surgery

Abstract

Arteriovenous fistula may be due to a vascular injury during various orthopedic surgeries. It may cause massive, unexpected bleeding during or following an operation or during rehabilitation. We report herein the case of a 48-year-old woman with a previous history of hip joint surgery due to congenital hip dislocation who experienced massive bleeding during a second operation. Postoperative pelvic angiography revealed large, complex arteriovenous fistulas with combined venous aneurysm. She was managed successfully by transarterial embolization.

Embolisation for Vascular Injuries Complicating Elective Orthopaedic Surgery

“…In addition, NBCA can be used in patients with clotting pathologies. 9,11 In our practice and the present study, NBCA was the preferred embolic agent because we consider it the most appropriate for controlled embolisation and permanent, complete occlusion of the bleeding vessels. If administered in low doses, sandwiched with glucosate under fluoroscopic control, post-embolisation complications are rare; if more volume of NBCA is administered at a time, it may reflux and occlude normal vessels.…”

“…Indications for embolisation are significant blood loss, coagulation defects, failure of surgical attempts by experienced personnel to control bleeding, recurrent bleeding, and bleeding sources at small branch vessels or non-critical axial vessels that are not immediately obvious and are amenable to embolisation. 2,3,11,16 In this series, after initial imaging evaluation with Doppler ultrasonography and CT scan, we performed diagnostic angiography that showed injuries of small branch vessels and noncritical axial vessels. These injuries were treated successfully with embolisation in all patients.…”

Malformação arteriovenosa incomum em artroplastia total do quadril: relato de caso de um perioperatório de curso complicado

“…Similar cases of malignant AVM and AVF around the hip have been described, but all were discovered years after the primary hip surgery. 3,8,9 This is the first reported case of a previously undiagnosed congenital AVM encountered during primary THA with associated development of symptomatic AVF in the immediate postoperative period.…”

“…1,2 Occurring in < 1% of THA procedures, the infrequency of arterial injuries makes it challenging for surgeons to recognize and properly diagnose it during the perioperative course. 2,5,6 Vascular injuries associated with THA occur due to the close proximity of the operating field with major blood vessels of the pelvis and of the lower extremity, 3,4 while being exposed to excessive force by retractors, acetabular reaming preparations, and hammering. 6 This is especially amplified in a population with higher rates of atherosclerosis and other peripheral vascular diseases.…”

“…2 Although rare, surgeons should be aware of these vascular malformations, as early recognition and intervention is critical in preventing limb-threatening ischemia or life-threatening hemorrhage. 3,4 According to current knowledge, this is the first reported case of primary THA in an elderly female using a direct anterior approach (DAA) with intraoperative discovery of a congenital AVM and subsequent development of a postoperative AVF with associated symptomatic hematomas. The case was successfully managed by selective endovascular coil embolization and blood transfusions.…”