Limits...
Acute Popliteal Artery Occlusion after Revision Total Knee Arthroplasty.

Tsujimoto R, Matsumoto T, Takayama K, Kawakami Y, Kamimura M, Matsushita T, Kuroda R, Kurosaka M - Case Rep Orthop (2015)

Bottom Line: We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital.In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion.Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 28110, Japan.

ABSTRACT
Acute arterial occlusions are a rare complication of total knee arthroplasty (TKA). However, in revision TKA, the risk of such complications is higher and these complications can lead to amputation if not adequately treated. We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital. Revascularization was achieved via bypass grafting and amputation was narrowly avoided despite time lag after symptom onset to revascularization. In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion. Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures.

No MeSH data available.


Related in: MedlinePlus

Arteriography of right knee showing the popliteal artery occlusion.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4556868&req=5

fig3: Arteriography of right knee showing the popliteal artery occlusion.

Mentions: 12 months after the last surgery, the second revision TKA was performed under general anesthesia, using a rotating-hinge knee implant (NexGen RH Knee, Zimmer, Warsaw, IN, USA). Prior to surgery, the limb was exsanguinated and the tourniquet was inflated to 280 mm Hg. The total tourniquet time was 167 minutes. The tourniquet was released before closing the surgical incision, and a 1200 mL hemorrhage was observed. The source of bleeding was unclear but stopped with hemostatic techniques and the surgery was completed (Figure 2). Immediately after surgery, the dorsalis pedis pulse weakened, and, four hours after surgery, the patient presented foot coldness, decreased sensation, and paresthesias; the dorsalis pedis pulse was not palpable. Emergency arteriography revealed arterial wall dissection and occlusion of the proximal popliteal artery (Figure 3). Thrombectomy with a Fogarty catheter was unsuccessful, so femoral artery to posterior tibial artery bypass with large saphenous vein graft and relaxing incision was immediately performed. The resumption of the lower limb circulation was confirmed by arteriogram 12 hours after the second revision TKA (Figure 4).


Acute Popliteal Artery Occlusion after Revision Total Knee Arthroplasty.

Tsujimoto R, Matsumoto T, Takayama K, Kawakami Y, Kamimura M, Matsushita T, Kuroda R, Kurosaka M - Case Rep Orthop (2015)

Arteriography of right knee showing the popliteal artery occlusion.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556868&req=5

fig3: Arteriography of right knee showing the popliteal artery occlusion.
Mentions: 12 months after the last surgery, the second revision TKA was performed under general anesthesia, using a rotating-hinge knee implant (NexGen RH Knee, Zimmer, Warsaw, IN, USA). Prior to surgery, the limb was exsanguinated and the tourniquet was inflated to 280 mm Hg. The total tourniquet time was 167 minutes. The tourniquet was released before closing the surgical incision, and a 1200 mL hemorrhage was observed. The source of bleeding was unclear but stopped with hemostatic techniques and the surgery was completed (Figure 2). Immediately after surgery, the dorsalis pedis pulse weakened, and, four hours after surgery, the patient presented foot coldness, decreased sensation, and paresthesias; the dorsalis pedis pulse was not palpable. Emergency arteriography revealed arterial wall dissection and occlusion of the proximal popliteal artery (Figure 3). Thrombectomy with a Fogarty catheter was unsuccessful, so femoral artery to posterior tibial artery bypass with large saphenous vein graft and relaxing incision was immediately performed. The resumption of the lower limb circulation was confirmed by arteriogram 12 hours after the second revision TKA (Figure 4).

Bottom Line: We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital.In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion.Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 28110, Japan.

ABSTRACT
Acute arterial occlusions are a rare complication of total knee arthroplasty (TKA). However, in revision TKA, the risk of such complications is higher and these complications can lead to amputation if not adequately treated. We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital. Revascularization was achieved via bypass grafting and amputation was narrowly avoided despite time lag after symptom onset to revascularization. In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion. Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures.

No MeSH data available.


Related in: MedlinePlus