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[Vascular lesions in surgery of the hip joint]
J Fruhwirth1, G Koch, G M Ivanic
1Klinische Abteilung für Gef sschirurgie, Uniersitätsklinik für Chirurgie, Graz.
Insights
Iatrogenic vascular injuries during total hip surgery, though rare at 0.3%, can cause severe bleeding or limb ischemia. Prompt surgical repair of arterial and venous damage is crucial for successful patient outcomes.
Area of Science:
- Vascular Surgery
- Orthopaedic Surgery
- Anatomy
Context:
- Acetabular region vascular anatomy poses risks during orthopaedic procedures.
- Iatrogenic vascular injuries include lacerations, thrombosis, pseudoaneurysms, and arteriovenous fistulas.
- Risk factors include screw fixation, cement protrusion, and instrument placement during hip surgery.
Purpose:
- To report on the incidence and management of vascular injuries associated with total hip arthroplasty.
- To highlight the types of vascular complications and their clinical presentation.
- To emphasize the importance of prompt diagnosis and surgical intervention.
Summary:
- Seven cases of arterial injury (3 external iliac, 4 femoral) and one pelvic vein injury were treated surgically over 5 years.
- Vascular lesions presented as acute ischemia or hemorrhage within 2 hours, or as a false aneurysm weeks later.
- Reconstruction involved direct suture or polytetrafluoroethylene (PTFE) grafts.
Impact:
- Recognizing and managing these rare but serious complications is vital for patient safety.
- Early identification and surgical repair of vascular injuries ensure satisfactory treatment outcomes.
- Understanding anatomical risks can help prevent iatrogenic vascular damage in hip surgery.
Abstract:
The vascular anatomy in the acetabular region involves a certain risk of arterial and venous injuries complicating orthopaedic surgery. These complications have been grouped into four categories: lacerations, thrombosis, pseudoaneurysms and arteriovenous fistula. In a period of 5 years, three injuries of the external iliac artery and four lesions of the femoral artery associated with total hip arthroplasty were treated surgically at the Department of Vascular Surgery of the University Hospital in Graz. In one case a concomitant lesion of the pelvic vein was observed. The incidence of iatrogenic vascular injuries in total hip surgery is 0.3%. Combined injury of the external iliac artery and vein led to a life-threatening bleeding complication. The vascular lesion became manifest as acute ischaemia of the lower extremity or as an acute haemorrhage 30 min to 2 h after primary surgery. The late complication of a false aneurysm of the femoral artery occurred in one patient 3 weeks after total hip replacement. Reconstruction of the vascular lesions was performed by direct suture, except that two arterial lesions required the use of polytetrafluoroethylene (PTFE) vascular grafts. Vessels in the pelvic region are at high risk if screw fixation acetabular components are used. Perforation of the iliac artery by protruded methylmethacrylate polymer components of cement has been documented. The obturator vessels are in a vulnerable position if the acetabular floor has been broached by operative instruments or eroded by loosening of the prosthesis facilitated by osteoporosis, steroids or sepsis. Femoral vessels are endangered by Hohmann retractors that are not placed directly on bone. Though vascular injury during hip operations is rare, recognition of such complications is important as safe and satisfactory treatment can be achieved. Rapid identification and immediate surgical repair of these lacerations are essential for their management.