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Endovascular embolisation is a successful and safe treatment for post-operative arterial complications after total hip arthroplasty and revision surgery

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Abstract

Purpose

Arterial complications are rare but clinically critical during or following total hip arthroplasty (THA) surgery. They usually require secondary interventions, either through open or endovascular approaches. In a retrospective study, we analysed indications for, as well as success and safety of, endovascular embolisation for arterial complications after THA.

Methods

We reviewed all arterial complications that had occurred through THA surgery and been treated by endovascular embolisation. We analysed angiographic findings, endovascular treatment, location in relation to the surgical approach and success of the interventions.

Results

Between 1997 and 2013 we performed 3,891 THAs at our hospital. We identified 14 patients with acute arterial complications treated by minimally invasive endovascular embolisation. Clinical findings included swelling of the ipsilateral leg, pain, prolonged wound bleeding, decreased haemoglobin and/or haemodynamic instability. Angiography revealed pseudoaneurysm in 11 patients, arteriovenous fistulas in two and extravasation of contrast media in one. Two patients showed no signs of acute bleeding. Twelve patients were treated, each with a single session of endovascular embolisation; in two additional patients, the haematoma was evacuated. No complications from the endovascular treatment were observed in this series.

Conclusion

Endovascular embolisation is a safe and successful minimally-invasive method to treat arterial injuries occurring through THA. Therefore, it should be considered as a first-line option of treatment for those injuries.

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References

  1. Calligaro KD, Dougherty MJ, Ryan S, Booth RE (2003) Acute arterial complications associated with total hip and knee arthroplasty. J Vasc Surg 38(6):1170–1177

    Article  PubMed  Google Scholar 

  2. Wilson JS, Miranda A, Johnson BL et al (2003) Vascular injuries associated with elective orthopedic procedures. Ann Vasc Surg 17:641–644. doi:10.1007/s10016-003-0074-2

    Article  PubMed  Google Scholar 

  3. Abularrage CJ, Weiswasser JM, Dezee KJ, Slidell MB, Henderson WG, Sidawy AN (2008) Predictors of lower extremity arterial injury after total knee or total hip arthroplasty. J Vasc Surg 47(4):803–807, discussion 7–8

    Article  PubMed  Google Scholar 

  4. Bergqvist D, Carlsson AS, Ericsson BF (1983) Vascular complications after total hip arthroplasty. Acta Orthop Scand 54:157–163

    Article  CAS  PubMed  Google Scholar 

  5. Kickuth R, Anderson S, Kocovic L et al (2006) Endovascular treatment of arterial injury as an uncommon complication after orthopedic surgery. J Vasc Interv Radiol 17:791–799. doi:10.1097/01.RVI.0000217929.35607.15

    Article  PubMed  Google Scholar 

  6. Shoenfeld NA, Stuchin SA, Pearl R, Haveson S (1990) The management of vascular injuries associated with total hip arthroplasty. J Vasc Surg 11:549–555. doi:10.1067/mva.1990.18087

    Article  CAS  PubMed  Google Scholar 

  7. Nozawa M, Irimoto M, Maezawa K et al (2000) False aneurysm of the profunda femoris artery after total hip arthroplasty. J Arthroplasty 15:671–674. doi:10.1054/arth.2000.4643

    Article  CAS  PubMed  Google Scholar 

  8. Carrafiello G, Fontana F, Mangini M et al (2011) Endovascular treatment in emergency setting of acute arterial injuries after orthopedic surgery. Cardiovasc Intervent Radiol 35:537–543. doi:10.1007/s00270-011-0207-x

    Article  PubMed  Google Scholar 

  9. Dhondt E, Vanhoenacker FM, d’ Archambeau O et al (2009) Angiographic findings and therapeutic embolization of late hemarthrosis after total joint arthroplasty. Skelet Radiol 38:31–36. doi:10.1007/s00256-008-0569-6

    Article  CAS  Google Scholar 

  10. Bach CM, Steingruber I, Wimmer C, Ogon M, Frischhut B (2000) False aneurysm 14 years after total hip arthroplasty. J Arthroplast 15(4):535–538 [Case Reports]

    Article  CAS  Google Scholar 

  11. Troutman DA, Dougherty MJ, Spivack AI, Calligaro KD (2013) Updated strategies to treat acute arterial complications associated with total knee and hip arthroplasty. J Vasc Surg 58:1037–1042. doi:10.1016/j.jvs.2013.04.035

    Article  PubMed  Google Scholar 

  12. Hans SS, Shepard AD, Reddy P et al (2011) Iatrogenic arterial injuries of spine and orthopedic operations. J Vasc Surg 53:407–413. doi:10.1016/j.jvs.2010.08.084

    Article  PubMed  Google Scholar 

  13. Parvizi J, Pulido L, Slenker N et al (2008) Vascular injuries after total joint arthroplasty. J Arthroplasty 23:1115–1121. doi:10.1016/j.arth.2008.02.016

    Article  PubMed  Google Scholar 

  14. Eslami MH, Silvia BA (2008) Endovascular repair of femoral artery pseudoaneurysm after orthopedic surgery with balloon-expandable covered stents. Vasc Endovasc Surg 42:176–179. doi:10.1177/1538574407307408

    Article  Google Scholar 

  15. Ulmar B, Aschoff AJ, Orend KH, Puhl W, Huch K (2004) Minimally invasive intervention for acute bleeding from a pseudoaneurysm after revision hip arthroplasty. Acta Orthop Belg 70(4):361–364 [Case Reports]

    PubMed  Google Scholar 

  16. Barriga A, Valentí Nin JR, Delgado C, Bilbao JJ (2001) Therapeutic embolisation for postoperative haemorrhage after total arthroplasty of the hip and knee. J Bone Joint Surg (Br) 83:90–92

    Article  CAS  Google Scholar 

  17. Helwig P, Uhl M, Niemeyer P et al (2008) Treatment options for perioperative hemorrhage: interventional angiography to control bleeding complications after total hip arthroplasty. Orthopade 37:470–474. doi:10.1007/s00132-008-1252-2

    Article  CAS  PubMed  Google Scholar 

  18. Mavrogenis AF, Rossi G, Rimondi E et al (2011) Embolisation for vascular injuries complicating elective orthopaedic surgery. Eur J Vasc Endovasc Surg 42:676–683. doi:10.1016/j.ejvs.2011.04.009

    Article  CAS  PubMed  Google Scholar 

  19. Callaghan JJ, Albright JC, Goetz DD et al (2000) Charnley total hip arthroplasty with cement. Minimum twenty-five-year follow-up. J Bone Joint Surg 82:487–497

    CAS  PubMed  Google Scholar 

  20. Holmberg A, Milbrink J, Bergqvist D (1996) Arterial complications after knee arthroplasty: 4 cases and a review of the literature. Acta Orthop Scand 67:75–78

    Article  CAS  PubMed  Google Scholar 

  21. Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg 89:780–785. doi:10.2106/JBJS.F.00222

    Article  PubMed  Google Scholar 

  22. Calligaro KD, Dougherty MJ, Ryan S, Booth RE (2003) Acute arterial complications associated with total hip and knee arthroplasty. J Vasc Surg 38:1170–1175. doi:10.1016/S0741-5214(03)00918-2

    Article  PubMed  Google Scholar 

  23. Carlin RE, Papenhausen M, Farber MA et al (2001) Sural artery pseudoaneurysms after knee arthroscopy: treatment with transcatheter embolization. J Vasc Surg 33(1):170–173 [Case Reports]

    Article  CAS  PubMed  Google Scholar 

  24. Lakomkin N, Greenberg SE, Obremskey WT, Sethi MK (2015) The risk of adverse events in orthopaedic trauma varies by anatomic region of surgery: an analysis of fifty thousand four hundred and twenty one patients. Int Orthop 39:2153–2159. doi:10.1007/s00264-015-2899-z

    Article  PubMed  Google Scholar 

  25. Bayne CO, Bayne O, Peterson M, Cain E (2008) Acute arterial thrombosis after bilateral total knee arthroplasty. J Arthroplasty 23:1239.e1–1239.e6. doi:10.1016/j.arth.2007.11.012

    Article  Google Scholar 

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    Authors and Affiliations

    1. Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

      Matthias Erschbamer, Daniel Sauter, Johannes Erhardt & Fabrice Külling

    2. Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

      Jürgen Den Hollander & Lukas Hechelhammer

    Authors
    1. Matthias Erschbamer
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    2. Jürgen Den Hollander
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    3. Daniel Sauter
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    4. Johannes Erhardt
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    Correspondence to Matthias Erschbamer.

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    None of the authors or their families received payments or had any financial interests related to this study.

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    Matthias Erschbamer and Jürgen Den Hollander contributed equally to this work.

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    Erschbamer, M., Den Hollander, J., Sauter, D. et al. Endovascular embolisation is a successful and safe treatment for post-operative arterial complications after total hip arthroplasty and revision surgery. International Orthopaedics (SICOT) 40, 1577–1582 (2016). https://doi.org/10.1007/s00264-015-3058-2

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    • DOI: https://doi.org/10.1007/s00264-015-3058-2

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