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Endovascular management of iliac vessel injury during revision of total hip replacement

  • Félix Tomé BermejoEmail author
  • Samuel Pajares Cabanillas
  • Luis Bonilla Madiedo
  • Manuel Doblas Dominguez
  • Ángel Flores Herrero
  • Enrique Criado
Case Report

Abstract

Re-operative hip arthroplasty may be associated with life threatening vascular complications involving the iliac arteries and veins. The anatomic distortion and difficult surgical dissection in a re-operative field often contributes to iliac vascular injuries. Bleeding during removal of the acetabular component of the hip prosthesis is often the initial sign of a major intra-operative vascular injury, the external iliac artery being the most common injured vessel. Preoperative identification of patients at risk for vascular injury during revision of hip arthroplasty is currently feasible and advisable with the information provided by plain X-ray films, angiography, CT-scan and nowadays with the 3D-angio-CT. The traditional approach for intra-operative exposure, control and repair of iliac vascular injuries during re-operative hip arthroplasty has been a retroperitoneal abdomino-pelvic incision. We here present an endovascular approach for the pre-emptive percutaneous control and potential repair of vascular injuries during a second hip arthroplasty revision in a patient at high risk for recurrent bleeding following severe hemorrhage during the initial hip revision.

Keywords

Vascular complications Total hip arthroplasty revision Acetabular protrusion External iliac artery External iliac vein 

Traitement endovasculaire d’une blessure des vaisseaux iliaques durant une reprise de prothèse de hanche

Résumé

La reprise d’une arthroplastie de hanche peut présenter des complications vasculaires représentant un danger pour la vie et impliquant les artères et les veines iliaques. Les modifications de l’anatomie et la dissection chirurgicale difficile dans un domaine remanié contribuent souvent à créer des lésions vasculaires iliaques. Un saignement pendant l’explantation de la cupule acétabulaire de la prothèse de hanche est souvent le signe initial de dommages vasculaires peropératoires importants, l’artère iliaque externe étant le vaisseau le plus souvent blessé. L’identification préopératoire des patients à risques vasculaires pendant la reprise d’une arthroplastie de hanche est possible et fiable de nos jours, grâce aux informations fournies par la gamme de l’imagerie médicale: radiographies standard, angiographie, scanner et angio-scanner. L’approche traditionnelle pour l’exposition, le bilan lésionnel et la réparation per-opératoire des blessures vasculaires iliaques pendant la reprise d’une arthroplastie de hanche est un abord rétro-péritonéal par incision abdomino-pelvienne. Nous présentons ici un cas d’abord endovasculaire pour le bilan lésionnel percutané d’une suspicion de blessure vasculaire ainsi que pour la possible réparation percutanée des dommages vasculaires pendant une reprise itérative d’arthroplastie de hanche chez un patient souffrant d’hémorragie récurrente après un important saignement per-opératoire.

Mots clés

Complications vasculaires Reprise d’arthroplastie totale de hanche Protrusion acétabulaire Artère iliaque externe Veine iliaque externe 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Félix Tomé Bermejo
    • 1
    • 4
    Email author
  • Samuel Pajares Cabanillas
    • 1
  • Luis Bonilla Madiedo
    • 1
  • Manuel Doblas Dominguez
    • 2
  • Ángel Flores Herrero
    • 2
  • Enrique Criado
    • 3
  1. 1.Department of Orthopaedic and Trauma SurgeryHospital Virgen de la SaludToledoSpain
  2. 2.Division of Vascular and Endovascular SurgeryHospital Virgen de la SaludToledoSpain
  3. 3.Vascular Surgery SectionUniversity of Michigan, School of MedicineAnn ArborUSA
  4. 4.MadridSpain

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