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AlShatti HJ, Ameer A, Rashid H. Unconventional Use of Balloon-Expandable Covered Stent in the Treatment of Iatrogenic Popliteal Pseudoaneurysm. Cureus 2023; 15:e41936. [PMID: 37583735 PMCID: PMC10425258 DOI: 10.7759/cureus.41936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/17/2023] Open
Abstract
Popliteal artery pseudoaneurysm is a rare injury occurring in total knee replacement surgeries. The symptoms are usually pain and swelling on the affected side which prompts immediate investigations. Surgical and endovascular interventions are both available options for intervention with covered stents being the preferred choice. In this study, we report the case of a 72-year-old female diagnosed with right popliteal artery pseudoaneurysm following total knee replacement which was managed with the insertion of an Atrium Advanta V12 balloon-expandable covered stent (Atrium Medical Corp., Hudson, NH, USA).
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Affiliation(s)
- Hamad J AlShatti
- Department of Surgery, Vascular Surgery Division, Jaber Al-Ahmad Hospital, Kuwait City, KWT
| | - Ahmad Ameer
- Department of Surgery, Vascular Surgery Division, Jaber Al-Ahmad Hospital, Kuwait City, KWT
| | - Hisham Rashid
- Department of Surgery, Vascular Surgery Division, Jaber Al-Ahmad Hospital, Kuwait City, KWT
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2
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Melian CM, Giannopoulos S, Tsouknidas I, Volteas P, Virvilis D, Nicholson J, Koullias GJ. Endovascular Repair Of Popliteal Artery Injury Post-Total Knee Arthroplasty is Safe and Effective: A Case Report And Systematic Review Of the Literature. Ann Vasc Surg 2023:S0890-5096(23)00105-X. [PMID: 36868455 DOI: 10.1016/j.avsg.2023.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Objective: Popliteal artery pseudoaneurysms are a rare but serious complication following total knee arthroplasty (TKA) that have been traditionally managed with open surgical repair. Endovascular stenting, while relatively new, offers a promising alternative that is less invasive and may reduce the risk of peri-operative complications. MATERIALS AND METHODS A systematic literature review was conducted and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, post-procedural complications and follow-up data were extracted and analyzed using STATA 14.1. Additionally, we present a case of a patient with a popliteal pseudoaneurysm treated with a covered endovascular stent. RESULTS A total of 14 studies (12 case reports, 2 case series; n= 17) were included for review. In all cases a stent-graft was placed across the popliteal artery lesion. In 5 out of 11 cases popliteal artery thrombus was present and treated with adjacent modalities (i.e. mechanical thrombectomy, balloon angioplasty, etc). Procedure success was reported in all cases without perioperative adverse events. Stents remained patent over a median follow up of 32 weeks (Interquartile range IQR: 36). In all but one case the patients experienced immediate symptom relief and had an uneventful recovery. For our case, at 12 months follow up the patient was asymptomatic, and ultrasound demonstrated vessel patency. CONCLUSION Endovascular stenting is a safe and effective treatment for popliteal pseudoaneurysms. Future studies should be aimed at evaluating the long-term outcomes of such minimally invasive techniques.
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Affiliation(s)
- Christina M Melian
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, Limb Preservation Center, Division of Vascular and Endovascular Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Ioannis Tsouknidas
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, Limb Preservation Center, Division of Vascular and Endovascular Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Dimitrios Virvilis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, Limb Preservation Center, Division of Vascular and Endovascular Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - James Nicholson
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - George J Koullias
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, Limb Preservation Center, Division of Vascular and Endovascular Surgery, Stony Brook University Hospital, Stony Brook, NY; Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
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3
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Sundaram K, Udo-Inyang I, Mont MA, Molloy R, Higuera-Rueda C, Piuzzi NS. Vascular Injuries in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 8:e0051. [PMID: 32105241 DOI: 10.2106/jbjs.rvw.19.00051] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Vascular injuries associated with total knee arthroplasty can have limb and life-threatening consequences. The aims of this study were to conduct a meta-analysis of the overall rate of vascular injuries after total knee arthroplasty and to conduct a systematic review of specific major and minor vessel injuries. METHODS All English-language literature published from January 1, 1998, to November 30, 2018, was queried in 4 unique databases using a common search term. This yielded 404 results, of which 270 were unique. Two reviewers then assessed studies for eligibility. All non-human studies, cadaver studies, studies describing only human images, and human studies with non-acute pathology were excluded. The final study included 10 large epidemiological studies and 68 case series or studies. Data from the literature were abstracted into a comma-separated database spreadsheet using Microsoft Excel. A meta-analysis was then performed. Pooled statistics were calculated with weighting by inverse variance assuming a random effect model. I was calculated as a quantifier of heterogeneity and interpreted according to the Cochrane manual. All data analysis was performed using R software. RESULTS Among the 1,419,557 total knee arthroplasties reported in 10 studies, there were 767 major vascular injuries (0.05% [54 per 100,000 total knee arthroplasties]). Amputation or long-term neurological complications occurred in approximately 21% of patients after major vascular injury. Presentation after 24 hours occurred in 36% of cases. The most frequently injured vessels were the geniculate arteries, popliteal artery, superficial femoral artery, and anterior tibial artery. The injuries that were most likely to result in amputation were femoral artery occlusion, popliteal artery transection, and popliteal artery arteriovenous fistula. CONCLUSIONS Amputation and long-term neurological complications are common complications after a vascular injury associated with a total knee arthroplasty. Preoperative consultation with vascular surgery physicians may be a prudent approach before a surgical procedure for patients with known peripheral vascular disease, diabetes, hypertension, or smoking; however, more data on risk factors are needed. Awareness by the surgical team and implementation of specific strategies during a surgical procedure such as gentle manipulation of the knee and careful retraction may further reduce the rate of injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kavin Sundaram
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
| | - Robert Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Daniels SP, Sneag DB, Berkowitz JL, Trost D, Endo Y. Pseudoaneurysm after total knee arthroplasty: imaging findings in 7 patients. Skeletal Radiol 2019; 48:699-706. [PMID: 30306198 DOI: 10.1007/s00256-018-3084-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/29/2018] [Accepted: 09/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the clinical presentation of arterial pseudoaneurysms following total knee arthroplasty (TKA) and their diagnostic imaging features on ultrasound and magnetic resonance angiography (MRA) in 7 patients. MATERIALS AND METHODS A search of our radiology report database from 2007 to 2017 yielded 7 patients with a pseudoaneurysm diagnosed by imaging after TKA. Clinical notes and imaging were reviewed. RESULTS All 7 patients were male and ranged in age from 53 to 68 (mean 61) years. All patients presented with a painful swollen knee and hemarthrosis within the first month following surgery. Five patients presented after primary TKA. One patient presented after explantation for septic arthritis and another after partial synovectomy for septic arthritis without explantation. Ultrasound identified the pseudoaneurysm as a hypoechoic or hyperechoic mass with a "yin-yang" appearance of turbulent arterial flow and associated complex joint effusion. On MRA, the pseudoaneurysm was a mass next to a parent artery showing avid contrast enhancement in the arterial phase that persisted into the venous phase and washed out in the late venous phase. Six pseudoaneurysms arose from lateral geniculate arteries and 1 from a medial geniculate artery. There were no popliteal artery pseudoaneurysms. Five patients were treated endovascularly, 1 patient thrombosed without intervention, and 1 patient was treated with open surgery. CONCLUSION Pseudoaneurysm is a potential source of a painful swollen knee with hemarthrosis or a drop in hematocrit after TKA and can be identified with either ultrasound or MRA.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
| | - Jennifer L Berkowitz
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
| | - David Trost
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.
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5
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Reynolds A, Sandstrom A, Jha PK. Totally Endovascular Management of Popliteal Artery Occlusion and Pseudoaneurysm Formation after Total Knee Replacement. Ann Vasc Surg 2017; 38:316.e13-316.e16. [DOI: 10.1016/j.avsg.2016.05.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 01/17/2023]
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6
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Raherinantenaina F, Rajaonanahary TMA, Rakoto Ratsimba HN. [Management of popliteal artery pseudoaneurysms as a result of limb trauma and orthopedic surgery or associated with osteochondromas]. Ann Cardiol Angeiol (Paris) 2016; 65:265-74. [PMID: 27236866 DOI: 10.1016/j.ancard.2016.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/29/2016] [Indexed: 11/15/2022]
Abstract
Most published articles regarding popliteal artery pseudoaneurysms (PAPs) are case reports and in English language literature. In this context, no study with robust data was previously published. The exact epidemiology of these APs is not well-known and their management is not yet codified. We wanted to summarize the current knowledge on diagnostic and therapeutic features of PAPs as a result of limb trauma and orthopedic surgery or associated with osteochondromas. An electronic research on MEDLINE and EMBASE between 1953 and March 2015 was performed; using the key words "popliteal pseudoaneurysm". The referenced articles were selectively read and this systematic review included 116 articles. Patient demographics; clinical presentations; diagnostic and therapeutic features were reviewed. In sum, 122 cases were analyzed. Overall young adult (average age=30.48±21.25 years old) represented the majority of the affected population with a masculine preponderance (79%). The main etiologies included femoral exostosis (63%), followed by the orthopedic surgery (25%) and direct trauma into the knee (10%). Painful swelling (44%) and/or pulsatile mass (39%) represented the most commonly presenting symptoms. The commonest radiological investigations used included arteriography (49%) and CTA (27%). The treatment was open surgical repair (85%) or endovascular stenting graft (14%). Post-therapeutic courses were often uneventful (98%). The morbidity rate was low at about 2%. The treatment of direct post-traumatic PAPs was usually open surgical repair (83%) with saphenous vein grafting. Endovascular stenting may be an ideal option for managing PAPs following orthopedic surgery (88%). Open surgery for vascular repair and maximum exostectomy must be undertaken concomitantly in the setting of APs associated with osteochondromas.
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Affiliation(s)
| | | | - H N Rakoto Ratsimba
- Service de chirurgie générale et vasculaire, CHU/HJRA, Tananarive, Madagascar
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7
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Tejero-Garcia S, Lirola Criado JF, Ast MP, Fernandez de Bobadilla GD. Popliteal pseudoaneurysm after unicompartmental knee replacement: a case report. Knee 2014; 21:597-9. [PMID: 24703686 DOI: 10.1016/j.knee.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 02/07/2013] [Accepted: 03/01/2013] [Indexed: 02/02/2023]
Abstract
UNLABELLED Popliteal pseudoaneurysm is a rare but important complication of knee arthroplasties. To our knowledge, this complication has not been reported previously in the literature after unicompartmental knee arthroplasty. Apart from intraoperatively caused arterial injuries, obese patients and other previous cardiovascular diseases may be potential factors of risks for pseudoaneurysm in knee surgeries. As it is an uncommon complication and it has inconspicuous symptoms, both diagnosis and treatment can be delayed. This means that a high level of suspicion is necessary to prevent serious complications derived from pseudoaneurysms. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sergio Tejero-Garcia
- Department of Orthopaedic Surgery, Hospitales Universitarios Virgen del Rocío, Manuel Siurot s/n 41013, Sevilla, Spain.
| | - Jose F Lirola Criado
- Department of Orthopaedic Surgery, Hospitales Universitarios Virgen del Rocío, Manuel Siurot s/n 41013, Sevilla, Spain.
| | - Michael P Ast
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
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8
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Popliteal lesion due to traction during unicompartmental knee revision surgery. J Orthop 2014; 10:38-40. [PMID: 24403746 DOI: 10.1016/j.jor.2013.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 01/01/2013] [Indexed: 11/22/2022] Open
Abstract
Popliteal artery injury is a rare but known complication in knee surgery. Only one article in current literature reports that the risk increases during revision knee surgery. A new case is described in which an injury to the popliteal artery occurred during lateral unicompartmental to total knee arthroplasty revision surgery. This vascular injury occurred 5-10 cm below the tibial resection level in a healthy patient with a history of cruris fracture with plate osteosynthesis and lateral unicompartmental knee arthroplasty. This paper stresses the importance of being aware that trauma and surgery can create fibrosis in which the popliteal artery can get fixated, thus reducing the scope for safe manipulation of the knee during secondary surgery.
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9
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Alserr AHK, Antonopoulos CN, Papapetrou A, Kakisis JD, Brountzos E, Liapis CD. Endovascular Repair of Popliteal Artery Pseudoaneurysm With Arteriovenous Fistula After Knee Arthroscopy. Vasc Endovascular Surg 2013; 48:166-70. [PMID: 24302163 DOI: 10.1177/1538574413512379] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report a case of postarthroscopic popliteal artery pseudoaneurysm (PSA) with arteriovenous fistula (AVF; PSA-AVF) in a 53-year-old woman who presented with limb edema, pain, and bruit 1 year after arthroscopic meniscectomy. She was treated percutaneously by covered stent deployment. After 6 months of follow-up, the patient was asymptomatic, with patency of the stent and occlusion of the AVF. A review of the literature was also performed to investigate the prevalence of postarthroscopic PSAs and highlight the endovascular approach of treatment. Endovascular approach with covered stent appears to be less invasive and might be an effective and feasible way of treatment of postarthroscopic popliteal PSA-AVF.
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Affiliation(s)
- Ayman H. K. Alserr
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | | | | | - John D. Kakisis
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | - Elias Brountzos
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | - Christos D. Liapis
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
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10
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González Rodríguez JC, Jordan Sales M, Aguilera Roig X, Monllau García JC, Celaya Ibañez F. [Popliteal pseudoaneurysm as a complication in total knee replacement. Presentation of a case and an updated literature review]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 56:205-9. [PMID: 23594807 DOI: 10.1016/j.recot.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 01/12/2012] [Indexed: 10/28/2022] Open
Abstract
Vascular complications are rare after total knee arthroplasty, and popliteal pseudoaneurysms are even more so. There are few cases reported in the literature. We present a case of an 80 year-old woman with osteoarthritis of the left knee, secondary to Genu varum, who was treated with total knee arthroplasty. On the discharge day after surgery, the patient suffered a popliteal pseudoaneurysm that was successfully treated with an intravascular stent introduced by an inguinal approach.
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Affiliation(s)
- J C González Rodríguez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Santa Cruz y San Pablo, Universidad Autónoma de Barcelona, Barcelona, España.
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11
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Aburahma Z, Hass SM. Endovascular repair of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery: case report and review of literature. Vascular 2013; 21:102-4. [PMID: 23526110 DOI: 10.1177/1708538113477799] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery. Endovascular repair was successfully used as the treatment for this patient and studies have shown this to be a safe alternative to surgery.
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Affiliation(s)
- Zachary Aburahma
- West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA
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12
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Abstract
We report a case of posttraumatic false aneurysm of popliteal artery after a total knee arthroplasty in an 82-year-old woman. This case is characterized by the distinct history of trauma to the popliteal fossa in the immediate postoperative period and the location of false aneurysm. In addition, the clinical symptoms were similar to those of deep vein thrombosis. The ultrasonographic examination and computed tomography (CT) angiography confirmed the diagnosis on 6(th) day after the surgery. Ultrasonographic examination 1 day later revealed no increase in the size of false aneurysm. She was treated with open surgical repair. Presenting the difficulty in the diagnosis, unusual location, etiology, and its management is the intention of this case report.
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Affiliation(s)
- Sanjay R Agarwala
- Department of Orthopaedics, P. D. Hinduja National Hospital and MRC, Mahim (W), Mumbai, Maharashtra, India,Address for correspondence: Dr. Sanjay R. Agarwala, Department of Orthopaedics, P. D. Hinduja National Hospital and MRC, Mahim (W), Mumbai, Maharashtra, India. E-mail:
| | - Ganesh S Mohrir
- Department of Orthopaedics, P. D. Hinduja National Hospital and MRC, Mahim (W), Mumbai, Maharashtra, India
| | - Sharukh J Dotivala
- Department of Orthopaedics, P. D. Hinduja National Hospital and MRC, Mahim (W), Mumbai, Maharashtra, India
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13
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González Rodríguez J, Jordan Sales M, Aguilera Roig X, Monllau García J, Celaya Ibañez F. Popliteal pseudoaneurysm as a complication in total knee replacement. A case report. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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14
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Carrafiello G, Fontana F, Mangini M, Ierardi AM, Laganà D, Piacentino F, Vizzari FA, Spanò E, Fugazzola C. Endovascular treatment in emergency setting of acute arterial injuries after orthopedic surgery. Cardiovasc Intervent Radiol 2011; 35:537-43. [PMID: 21691918 DOI: 10.1007/s00270-011-0207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/25/2011] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the feasibility and effectiveness of emergency endovascular treatment of acute arterial injuries after orthopedic surgery. MATERIALS AND METHODS Fifteen patients (mean age 68.3 years) with acute arterial injuries after orthopedic surgery were observed, in particular, 5 patients with pseudoaneurysm, 9 patients with active bleeding, and 1 patient with arterial dissection. Transarterial embolization (TAE) and positioning of covered and noncovered stents were the treatments performed. Follow-up after stent implantation (mean 36 months) was performed with color Doppler US (CDU) at 1, 3, 6, and 12 months and yearly thereafter. Plain X-ray was performed to evidence dislodgment or fracture of the graft. A minimum of 12 months' follow-up is available after TAE. RESULTS Immediate technical success was obtained in all cases. No major complications occurred. Overall clinical success rate was 100%. During mean follow-up, stent-graft occlusions did not occurred. No recurrence and/or consequence of TAE was registered during a minimum follow-up of 12 months. CONCLUSIONS Percutaneous treatment is a feasible and safe tool for treating arterial injuries because it can provide fast and definitive resolution of the damage. This low-invasiveness approach can be proposed as first-line treatment in patients with acute injuries after orthopedic surgery.
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Affiliation(s)
- Gianpaolo Carrafiello
- Interventional Radiology, Department of Radiology, Insubria University, 57, 21100, Varese, Italy.
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15
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Endovascular repair of iatrogenic popliteal artery trauma. Eur J Trauma Emerg Surg 2011; 38:617-22. [DOI: 10.1007/s00068-011-0124-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 05/21/2011] [Indexed: 11/25/2022]
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16
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Butt U, Samuel R, Sahu A, Butt IS, Johnson DS, Turner PG. Arterial injury in total knee arthroplasty. J Arthroplasty 2010; 25:1311-8. [PMID: 20580198 DOI: 10.1016/j.arth.2010.05.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 03/15/2010] [Accepted: 05/03/2010] [Indexed: 02/01/2023] Open
Abstract
Arterial complications associated with knee arthroplasty are relatively rare, although probably underreported, complications of knee arthroplasty that carry a risk of significant morbidity. Thorough preoperative assessment and close liaison with a vascular surgeon, combined with an appreciation of common anatomical variants or distorted anatomy, may help prevent both thromboembolic and direct injuries from occurring. Clinical features of arterial complications following knee arthroplasty may vary significantly from acute hemorrhage or ischemia in the immediate postoperative period to chronic pain and swelling presenting even months following the procedure. There is potential for diagnostic confusion and delay that may adversely affect outcome. Early diagnosis along with vascular surgical review and intervention is key to successful management.
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Affiliation(s)
- Usman Butt
- Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, Manchester, UK
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17
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Case series and literature review: Popliteal artery injury following total knee replacement. Int J Surg 2010; 8:430-5. [DOI: 10.1016/j.ijsu.2010.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 03/29/2010] [Accepted: 04/21/2010] [Indexed: 11/13/2022]
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18
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Cowell GW, Boom SJ, Ablett MJ. Thrombosis of popliteal artery pseudoaneurysm by deployment of angioplasty balloon after total knee arthroplasty. J Arthroplasty 2009; 24:825.e11-3. [PMID: 18824326 DOI: 10.1016/j.arth.2008.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 05/16/2008] [Accepted: 07/29/2008] [Indexed: 02/01/2023] Open
Abstract
Vascular complications after total knee arthroplasty are rare, with incidence ranging between 0.03% and 0.2%. We describe a case of a popliteal artery false aneurysm after total knee arthroplasty successfully treated by deployment of an angioplasty balloon across the aneurysm neck resulting in thrombosis.
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19
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Sloan K, Mofidi R, Nagy J, Flett MM, Chakraverty S. Endovascular treatment for traumatic popliteal artery pseudoaneurysms after knee arthroplasty. Vasc Endovascular Surg 2009; 43:286-90. [PMID: 19131373 DOI: 10.1177/1538574408328664] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma to the popliteal artery is a recognized complication of knee arthroplasty (total knee arthroplasty). It can present in a variety of ways, one of which is the development of popliteal artery pseudoaneurysm. We report the successful endovascular management of 2 patients who developed popliteal artery pseudoaneurysms following total knee arthroplasty using covered stent grafts. From presented evidence, endovascular therapy is a safe treatment modality and it appears to be a viable alternative to open surgery.
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Affiliation(s)
- Keren Sloan
- Department of Vascular Surgery, Ninewells Hospital, Dundee DD1 9SY, United Kingdom
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20
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Sadat U, Kullar PJ, Noorani A, Gillard JH, Cooper DG, Boyle JR. Emergency endovascular management of peripheral artery aneurysms and pseudoaneurysms - a review. World J Emerg Surg 2008; 3:22. [PMID: 18644114 PMCID: PMC2494545 DOI: 10.1186/1749-7922-3-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 07/21/2008] [Indexed: 11/14/2022] Open
Abstract
Endovascular stenting has been successfully employed in the management of aortic aneurysms; however, its use in managing peripheral arterial conditions remains questionable. We review the utility of endovascular technique in the management of peripheral arterial conditions like aneurysms, pseudoaneurysms and arterio-venous fistulas in the emergency setting. Though long term data about graft patency rates is not yet available, the endovascular approach appears to be a useful minimally invasive technique in situations where open repair is either difficult or not feasible.
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Affiliation(s)
- Umar Sadat
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, UK.
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de Koning HD, Zeebregts CJ, Reijnen MMPJ. Hybrid treatment of a symptomatic popliteal pseudoaneurysm due to type-I endoleak after previous endovascular exclusion. Catheter Cardiovasc Interv 2008; 71:983-6. [PMID: 18324701 DOI: 10.1002/ccd.21471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The development of endovascular repair of popliteal aneurysms has provided an alternative, minimally invasive way of treatment. We present a case of a late type-I endoleak, after previous exclusion of a popliteal pseudoaneurysm, leading to rupture and massive hematoma, which was excluded in a hybrid procedure. CASE REPORT A 95-year-old woman presented with progressive swelling with skin ulceration and necrosis cranial to the medial side of her left knee. Four years earlier, a left popliteal pseudoaneurysm was excluded with a stent-graft. Rupture of the popliteal artery with massive hematoma was demonstrated by ultrasound examination and a spiral computed tomography scan, with high suspicion of a type-I endoleak. Endovascular repair of the endoleak with a polytetrafluoroethylene-covered stent-graft was followed by surgical resection of the damaged skin and evacuation of the hematoma. CONCLUSION Type-I endoleaks after endovascular exclusion of popliteal pseudoaneurysms do occur and may lead to rupture. A symptomatic pseudoaneurysm may be successfully treated by a hybrid procedure.
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Affiliation(s)
- Heleen D de Koning
- Department of Surgery (Division of Vascular Surgery), Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
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Reijnen MMPJ, de Rhoter W, Zeebregts CJ. Treatment of a symptomatic popliteal pseudoaneurysm using a stent-graft and ultrasound-guided evacuation of the haematoma. Emerg Radiol 2008; 16:167-9. [DOI: 10.1007/s10140-008-0702-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Accepted: 01/08/2008] [Indexed: 10/22/2022]
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Blanco-Cañibano E, García-Fresnillo B, Guerra-Requena M. Pseudoaneurisma de la arteria poplítea como complicación de la cirugía de prótesis de rodilla: tratamiento endovascular. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)01006-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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