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, Triller, Kurt-Jürgen
ISSN:	1051-0443
ISBN:	16687744
Publisher:	Elsevier
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:46
Last Modified:	05 Dec 2022 14:14
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)