Arterial Injuries During Total Knee Arthroplasty - Case Series
Tamas Kovacs1, Anthony W. Lee2, John C. Motta2.
1Florida Atlantic University, Boca Raton, FL, USA, 2Boca Care Vascular Surgery, Boca Raton, FL, USA.
Demographics
Arterial injuries during elective orthopedic procedures are rare complications, however with possibly devastating consequences. Total knee arthroplasties are associated with vascular injuries three times as frequently as total hip arthroplasties.
History
Here we report four cases that were associated with total knee replacements.
Plan
Case 1: The patient is a 79 year old man, with a h/o ipsilateral SFA stent placement, who underwent a left TKA with thigh tourniquet. Postoperatively, he had a cool left foot with absent popliteal pulse and weakly dopplerable pedal signals. Angiography revealed 15 cm SFA occlusion, patent popliteal artery and two vessel runoff. The occluded segment was angioplastied and re-stented.
Case 2: The patient is a 58 year old woman who underwent a left TKA without a tourniquet. On POD 1 patient complained of left foot pain. On exam a large pulsatile mass was palpable in the popliteal fossa with dopplerable pedal signals. Duplex and angiography revealed a 3.8 cm pseudoaneurysm and occluded popliteal artery. Intraoperative findings confirmed a complete transection of the popliteal artery and a vein graft bypass was performed.
Case 3: The patient is a 66 year old woman who underwent a left TKA under spinal anesthesia, without a tourniquet. In PACU she had a cool left foot and absent pedal signals. Urgent angiography revealed popliteal occlusion with extravasation of contrast and sluggish flow in the posterior tibial artery. Exploration showed laceration of the popliteal vein and complete transection of the artery. The vein was repaired with a lateral venorrhaphy, and the artery was mobilized and primary end-to-end anastomosis was able to be performed. She had palpable pedal pulses and an uneventful postoperative course.
Case 4: The patient is a 57 year old male who had TKR with 2 hour tourniquet time. Postoperatively his left foot was found to be pulseless without Doppler signals. Angiography revealed no flow from the popliteal artery distal to the foot. Open popliteal thrombectomy, PTA and covered stent placement were performed.
Discussion
We reported 4 cases of arterial injuries after TKAs. One involved the SFA and two the popliteal arteries. In all cases, the patients presented with immediate ischemic symptoms. Risk factors for arterial injury include preexisting peripheral arterial disease, revision surgery and African-American race.
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