Endovascular treatment of arterial injury as an uncommon complication after orthopedic surgery

Kickuth, Ralph; Anderson, Suzannne; Kocovic, Leonardo; Ludwig, Karin; Siebenrock, Klaus; Triller, Jürgen (2006). Endovascular treatment of arterial injury as an uncommon complication after orthopedic surgery. Journal of vascular and interventional radiology, 17(5), pp. 791-9. New York, N.Y.: Elsevier 10.1097/01.RVI.0000217929.35607.15

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PURPOSE: To evaluate selective and superselective catheter therapy of serious arterial damage associated with orthopedic surgery of the pelvis, hip joint, femur, and knee. MATERIALS AND METHODS: Between 1989 and 2005, 16 consecutive patients with arterial damage after orthopedic surgery (seven women, nine men; mean age, 62 years; age range, 21-82 y) underwent angiographic exploration. Seven patients were in hemodynamically unstable condition. Initial orthopedic procedures were iliac crest internal fixation (n = 1); total hip prosthesis (n = 3); revision of total hip prosthesis (n = 4); revision of acetabular cup prosthesis (n = 1); gamma-nailing, nail-plate fixation, or intramedullary nailing (n = 3); and total knee prosthesis (n = 4). RESULTS: Angiography showed pseudoaneurysms (n = 11), vascular lacerations with active extravasation (n = 3), and arteriovenous fistulas with extravasation (n = 2). After angiographic documentation of serious arterial injury, 14 patients were treated with a single or coaxial catheter technique in combination with coils alone, coils and polyvinyl alcohol particles, coils and Gelfoam pledgets, or Gelfoam pledgets; or balloon occlusion with isobutyl cyanoacrylate and coils. Two patients were treated with covered stents. In all, bleeding was effectively controlled in a single session in 16 patients, with immediate circulatory stabilization. Major complications included death, pulmonary embolism, and postprocedural hematoma. CONCLUSION: Selective and superselective catheter therapy may be used for effective, minimally invasive management of rare but potentially life-threatening vascular complications after orthopedic surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Kickuth, Ralph; Anderson, Suzanne E.; Siebenrock, Klaus-Arno and Triller, Kurt-Jürgen

ISSN:

1051-0443

ISBN:

16687744

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:46

Last Modified:

06 Dec 2013 13:42

Publisher DOI:

10.1097/01.RVI.0000217929.35607.15

PubMed ID:

16687744

Web of Science ID:

000237612300006

URI:

https://boris.unibe.ch/id/eprint/19247 (FactScience: 1740)

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