Consequences of serious vascular injuries during total hip
replacement
Updated 7/2/09 |
Link
http://www.cja-jca.org/cgi/content/full/49/3/323
Canadian
Anesthesiologists' Society, 2002
Life threatening external iliac
artery injury following total hip replacement
Mahesh Kumar Arora, MD, Anuj Bhatia, MD DNB, Ganga Prasad, MD and
Subramanyam M.S., MD DNB
New Delhi, India
To the Editor:
Consequences of serious vascular injuries during total hip replacement (THR)
have received little attention in the anesthesia literature as these
rarely present in the immediate postoperative period.1 We report the
anesthetic and intensive care management implications of an undiagnosed
external iliac artery injury following THR. A 36-yr-old male weighing 56
kg underwent THR under general anesthesia for osteonecrosis of the right
femoral head. After an uneventful induction and maintenance of
anesthesia, he developed manifestations of hypotension towards the end
of surgery which persisted in the immediate postoperative period. The
hemoglobin concentration fell from 11 g•dL-1 to 7 g•dL-1 along with a
fall in central venous pressure and urine output in the immediate
postoperative period. Colloids and blood products were administered to
improve volume status but hypotension persisted and vasopressor
infusions were started. The patient remained hemodynamically unstable,
developed metabolic acidosis and required intubation and ventilation six
hours after surgery. Increasing distension in the right lower quadrant
of the abdomen was noticed. A diagnosis of retroperitoneal bleeding was
made and an emergency laparotomy performed. Operative findings included
a large retroperitoneal hematoma extending up to the diaphragm. The
screw used for THR had perforated the right external iliac artery.
Evacuation of the hematoma and end-to-end anastomosis of the artery were
preformed under general anesthesia. The patient was extubated 24 hr
after the laparotomy and had an uneventful postoperative course.
External iliac and femoral vessels lie in close proximity to the hip
joint and hence are prone to injury during the operation.2 A high index
of suspicion and aggressive hemodynamic management involving fluid
therapy, inotropes, invasive perioperative monitoring, vasopressors and
early surgery will help prevent morbidity and mortality.
References
1 Nachbur B, Meyer RP, Verkkala K, Zurcher R. The mechanisms of severe
arterial injury in surgery of the hip joint. Clin Orthop 1979; 141:
122–33.
2 Salama R, Stavorovsky MM, Iellin A, Weissman SL. Femoral artery injury
complicating total hip replacement. Clin Orthop 1972; 89:
143–4.[Medline]
