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External iliac artery thrombosis associated with the ilio-inguinal approach in the management of acetabular fractures: a case report.

Klos K, Marintschev I, Böttcher J, Hofmann GO, Mückley T - J Med Case Rep (2008)

Bottom Line: In the recovery room, his left lower limb was found to be cool and pale.We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury) and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented.High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Traumatology, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Jena, Germany. kajetan.klos@med.uni-jena.de

ABSTRACT

Introduction: The ilio-inguinal approach has come to be used routinely in the management of acetabular fractures involving the anterior wall. Thrombotic complications following surgery via this route are a serious, but rare, complication.

Case presentation: We report the case of a 66-year-old male patient who slipped on an icy pavement and fell on his left hip. He sustained a comminuted acetabular fracture (a transtectal T-fracture with an incomplete posterior stem through the ischial tuberosity), and was operated on five days later, via an ilio-inguinal approach. In the recovery room, his left lower limb was found to be cool and pale. Immediate re-exploration showed a left external iliac artery thrombosis, and thrombectomy was performed. In the surgical management of acetabular fractures, thrombosis of a major pelvic artery is a rare but potentially devastating complication. We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury) and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented.

Conclusion: We recommend circulation monitoring in patients with acetabular fractures, especially where nerve blocks and/or deep sedation/analgesia have been used. High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.

No MeSH data available.


Related in: MedlinePlus

Thrombectomy.
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Figure 2: Thrombectomy.

Mentions: In the recovery room, the patient's left lower limb was found to be cool and pale; no pulses could be palpated. The patient was therefore returned to the operating theatre; the external iliac artery on the operated side was explored and found to be thrombosed (Fig. 2).


External iliac artery thrombosis associated with the ilio-inguinal approach in the management of acetabular fractures: a case report.

Klos K, Marintschev I, Böttcher J, Hofmann GO, Mückley T - J Med Case Rep (2008)

Thrombectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2267470&req=5

Figure 2: Thrombectomy.
Mentions: In the recovery room, the patient's left lower limb was found to be cool and pale; no pulses could be palpated. The patient was therefore returned to the operating theatre; the external iliac artery on the operated side was explored and found to be thrombosed (Fig. 2).

Bottom Line: In the recovery room, his left lower limb was found to be cool and pale.We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury) and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented.High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Traumatology, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Jena, Germany. kajetan.klos@med.uni-jena.de

ABSTRACT

Introduction: The ilio-inguinal approach has come to be used routinely in the management of acetabular fractures involving the anterior wall. Thrombotic complications following surgery via this route are a serious, but rare, complication.

Case presentation: We report the case of a 66-year-old male patient who slipped on an icy pavement and fell on his left hip. He sustained a comminuted acetabular fracture (a transtectal T-fracture with an incomplete posterior stem through the ischial tuberosity), and was operated on five days later, via an ilio-inguinal approach. In the recovery room, his left lower limb was found to be cool and pale. Immediate re-exploration showed a left external iliac artery thrombosis, and thrombectomy was performed. In the surgical management of acetabular fractures, thrombosis of a major pelvic artery is a rare but potentially devastating complication. We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury) and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented.

Conclusion: We recommend circulation monitoring in patients with acetabular fractures, especially where nerve blocks and/or deep sedation/analgesia have been used. High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.

No MeSH data available.


Related in: MedlinePlus