Vascular complications in orthopaedic surgery

Vascular complications during orthopaedic surgery, although rare, do occur. Most vascular complications occur intraoperatively, immediately postoperatively or in the late postoperative period; they most commonly include lacerations, pseudoaneurysms, thrombosis, and arteriovenous fistulas. The operations most commonly associated with vascular injuries are knee arthroplasty, followed by hip arthroplasty, spinal surgery, and knee arthroscopy. Most commonly the popliteal artery is involved, followed by the tibial, superficial femoral, iliac, common and profunda femoral arteries. Color Doppler ultrasound is the initial imaging method used to evaluate a vascular injury. Computed tomography and magnetic resonance angiography are usually not applicable in joint replacement surgery because of the artifacts caused by the prostheses. When noninvasive imaging fails to reveal the injury, angiography is required. Traditional management of vascular surgical complications have included vascular surgical intervention. However, the availability of a vascular surgical team is required, and re-exploration of the operative site to treat acute ischemic complications of joint replacement may be difficult and may fail because the source of bleeding is not always apparent. In this setting, endovascular treatments such as balloon arterial thrombectomy, balloon angioplasty with and without stenting, and transcatheteral selective arterial embolization have been effective, successful, and safe interventional techniques in the acute or late postoperative period after elective orthopedic surgery. These techniques should be considered as the first option in the treatment of these lesions.