[Arterial trauma in hip arthroplasty]. / Traumatismos arteriales en artroplastia de cadera.

INTRODUCTION: Arterial injuries due to total hip arthroplasty can be a serious complication. The risk of vascular injury is related to proximity of the structures, tractions, and the aggressive use of instruments. OBJECTIVES: To analyze the frequency, injury mechanism, clinical presentation and therapeutic options in this kind of injury. PATIENTS AND METHOD: A group of 4162 patients subjected to total hip arthroplasty between 1986 and 2006 (reinterventions 7.2%). We describe 8 cases (5 women and 3 men) with a mean age of 61 years (reinterventions 50%). The vascular surgery was performed at less than 1 hour (n = 4), 6 hours (n = 2), 16 hours (n = 1) and 20 days (n = 1). RESULTS: The most frequent locations were external iliac artery (n = 3), common femoral (n = 3), internal iliac (n = 1) and deep femoral (n = 1). The clinical presentation was, internal bleeding (50%), acute limb ischemia (37%) and subacute limb ischemia (13%). The surgical interventions were bypass (50%), arteriorrhaphy (25%), primary repair (12.5%), and thrombectomy and patching (12.5%). One case was reoperated 6 years later, as we found a false anastomotic aneurism in a previous ilio-femoral bypass. The death and amputation rates were 0%. CONCLUSIONS: Although these injuries are rare, they involve a life-threatening complication. The external iliac artery/common femoral artery are the most frequent location. Most patients required a bypass, although the surgical technique depends on the injury location.

Inflammatory aneurysm in the infrarenal portion of thoracoabdominal aneurysms: an uncommon variant.

INTRODUCTION: We present an unusual variant of type IV thoracoabdominal aneurysm with inflammatory changes in part of the aortic wall. MATERIAL AND METHODS: Between January 1990 and December 2000, 5 male patients (mean age, 68 years) with inflammatory aneurysms of 29 with type IV thoracoabdominal aneurysms (17.2%) underwent surgery. All five had arterial hypertension. The diagnosis of inflammatory aneurysm was made on the basis of clinical suspicion supported by characteristic features on CT scans. Endoaneurysmorraphy was performed in all cases; a tube graft was inserted in three cases, and bifurcation was performed in 2. The macroscopic appearance of periaortic fibrosis was detected at the infrarrenal portion of the aneurysm in the 5 patients, but no retroperitoneal fibrosis was found at the level of the distal thoracic aorta in any case. RESULTS: There was no operative mortality. Paraparesis was not detected in any patient. One patient had acute kidney failure, and another required an extended stay in the intensive care unit because of respiratory insufficiency. Pathologic examination confirmed the diagnosis of inflammatory aneurysm in all 5 patients, with characteristic adventitial thickening caused by lymphoplasmacytic infiltrate and fibrosis around the ganglionic and nerve structures. CONCLUSIONS: Type IV thoracoabdominal aneurysm with inflammatory changes can be treated at surgery with a retroperitoneal approach. Usually the fibrotic response is confined to the infrarenal portion of the aneurysm.

Obstructive ARF caused by an inflammatory abdominal aortic aneurysm.

Inflammatory abdominal aortic aneurysms are rare entities characterized by dense fibrosis typically enveloping the aortic wall and adjacent structures with distinctive clinical features that differentiate them from typical atherosclerotic aneurysms. The inflammatory process can involve the renal excretory pathways, causing ureteral obstruction in 20% of cases. The authors report 2 cases of complete obstructive anuria secondary to inflammatory aneurysms and discuss the most appropriate management for these situations of hydronephrosis. Surgical repair of the aneurysm usually leads to regression of the inflammatory reaction.