Endovascular treatment in emergency setting of acute arterial injuries after orthopedic surgery

Cardiovasc Intervent Radiol. 2012 Jun;35(3):537-43. doi: 10.1007/s00270-011-0207-x. Epub 2011 Jun 21.

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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, False / diagnostic imaging
  • Aneurysm, False / therapy*
  • Angiography
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / therapy*
  • Arteries / injuries*
  • Contrast Media
  • Emergency Treatment*
  • Endovascular Procedures*
  • Female
  • Follow-Up Studies
  • Hemorrhage / diagnostic imaging
  • Hemorrhage / therapy*
  • Humans
  • Iopamidol / analogs & derivatives
  • Male
  • Middle Aged
  • Orthopedic Procedures*
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / therapy*
  • Retrospective Studies
  • Stents*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Triiodobenzoic Acids
  • Ultrasonography, Doppler, Color

Substances

  • Contrast Media
  • Triiodobenzoic Acids
  • iomeprol
  • iodixanol
  • Iopamidol