Vascular Injuries Associated with Orthopedic Procedures - Beware of the Cement
Joann Lohr1, Emily Wright2, Michael Wolujewicz, Wolujewicz2.
1Lohr Surgical Specialists, Cincinnati, OH, USA, 2Trihealth, Cincinnati, OH, USA.
OBJECTIVE- Vascular injuries are not rare during orthopedic procedures. Most common vascular issues are thrombotic in nature. Arterial issues are more commonly recognized in the acute situation. Venous injurious, especially extrinsic compression and May Thurner type disease are frequently not detected until well after the orthopedic intervention. We describe two cases of extrinsic compression at the level of the replaced joint due to extruded cement and malpositioning.
METHODS- Reports of two cases and retrospective review of literature.
RESULTS- Our first case is a 71 year old male with a history of iliofemoral DVT complicated by post thrombotic syndrome in 2007. He underwent left hip replacement in 2011 with significant worsening of his symptoms. A postop venogram revealed extrinsic compression of his iliac and femoral veins at the level of the surgery site. The second patient is a 68 year old female who showed venogram evidence of focal stenosis distal to the left external iliac vein after a left total hip replacement. IVUS confirmed extrinsic compression. Both patients were subjected to endovenous interventions but failed.
CONCLUSIONS- These cases demonstrate the importance of recognizing venous damage after orthopedic surgeries, especially in the elderly. Any patient who has undergone orthopedic intervention and who has unilateral limb swelling should be examined for both external and internal damage to vessels. Although arterial damage will be discovered in the acute surgical setting (or soon after), venous damage may present much later and with much more subtlety. Much emphasis has also been placed on monitoring for DVT and pulse change. However, limited venous outflow caused by external compression by way of orthopedic cement can easily be missed in the acute setting. It should be recognized as soon as possible. Limited cement use may avoid or decrease the significant associated morbidity of misplace or extruded cement.
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