Vascular complications associated with orthopedic procedures

Damage to vascular structures during orthopedic procedures occurs relatively infrequently; when it does occur, however, recognition and prompt intervention are essential. We report herein 11 vascular injuries secondary to orthopedic procedures encountered between 1978 and 1988. Two injuries occurred as a consequence of lumbar laminectomy, three as a result of total hip replacement, three secondary to open reduction and internal fixation of a fracture of a lower extremity, two secondary to attempted closed reduction of humeral fractures and one injury as a result of hip flexion contracture release. Injury occurred to three iliac arteries, three popliteal arteries, two brachial arteries, one femoral artery, one graft to femoral anastomosis and two iliac veins. Five arterial injuries were repaired primarily, one with a vein patch, while five required bypass grafts. One venous injury was repaired primarily and the other required placement of a Greenfield filter for thrombosis. Major complications were a result of diagnostic delay and subsequent ischemia in most patients. There were no deaths. We conclude that vascular injuries can occur as a result of laceration, compression or traction during orthopedic procedures as a result of the proximity of vascular structures to the spine, joints and long bones. Also, we conclude that injuries manifest themselves primarily as hemorrhage or ischemia; that excellent results can be obtained with prompt recognition and treatment; that angiography is useful in those with mild ischemia in whom diagnosis is delayed, and that preoperative documentation of the vascular status of patients is critical prior to orthopedic procedures.