[Vascular complications in surgery of the hip joint]

The mechanisms of severe vascular injury during surgery of the hip joint are depicted with reference to the authors' own patient series and a review of the literature. Massive arterial hemorrhage is most commonly caused by the tip of a Hohmann retractor. Special care must be given to placement of the proximal retractor directly against the pelvis behind the anterior lip of the acetabulum, and this must be checked with the finger tip. Other mechanisms of injury are: massive venous bleeding can result if a coil of pelvic vein is rolled up with a Kirschner wire; arterial thrombosis can be caused by the polymerization heat of bone cement; or intimal dissection can be caused by pressure of a retractor or loosening of an intimal plaque, resulting in ischemia of the corresponding limb; arterio-arterial embolism can originate from appositional thrombus formation on a chronically weakened arterial wall; false aneurysms may be due to instrumental arterial injury; and arteriovenous fistulae can be caused by a piercing instrument. Laceration of the external iliac or common femoral artery is best treated by interposition of a saphenous vein graft. Angiological examination before and immediately after hip surgery is advocated.