ABSTRACT
Injuries to the pelvic vasculature during total hip arthroplasties are rare but have serious consequence. They demand urgent and early identification so that appropriate treatment can be instituted. If the bleeding is severe, cardiovascular compromise occurs intraoperatively and this will alert the surgeon of this possibility during acetabular screw placement. Alternatively, a delay in diagnosis can occur because the bleeding and the injured vessel are in the pelvic cavity and not visualized during the surgery. In this article, we report two cases from our center occurring within a six-month interval that sustained a vascular injury during acetabular drilling for screw placement for cementless cup fixation. Each case had a different vessel injury and different lessons can be learned from these rare injuries. The first case had an injury of the inferior gluteal artery following a breach of the sciatic notch. The vessel was treated with percutaneous embolization. The second case demonstrated a venous injury, following a medial protrusio technique for congenital hip dysplasia and a short anterosuperior screw, transecting the external iliac vein. This was subsequently repaired using an endovascular technique. We conclude the reasons for these vessel injuries after analyzing advanced imaging, discuss measures to avoid vessel injury and detail the minimally invasive method for their treatment.
Subject(s)
Acetabulum , Arthroplasty, Replacement, Hip , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Intraoperative Complications , Pelvis , Vascular System Injuries , Acetabulum/diagnostic imaging , Acetabulum/surgery , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/instrumentation , Arthroplasty, Replacement, Hip/methods , Bone Screws , Female , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Intraoperative Complications/therapy , Male , Middle Aged , Pelvis/blood supply , Pelvis/surgery , Preoperative Care/methods , Risk Adjustment/methods , Vascular System Injuries/diagnosis , Vascular System Injuries/etiology , Vascular System Injuries/prevention & control , Vascular System Injuries/therapyABSTRACT
Aortic malignant neoplasms are rare; these may be primary or secondary (metastatic). Increasing use of cross-sectional imaging has allowed better detection and diagnosis of these conditions. We encountered a young woman presenting with acute abdomen who was found on cross-sectional imaging to have a malignant tumor involving the aortic bifurcation. An en bloc excision of the tumor was performed, with distal aorta reconstruction using an aortoiliac Dacron graft; this was complicated with infection and graft occlusion, necessitating total removal and extra-anatomic bypass. A pathologic diagnosis of metastatic adenocarcinoma involving the aortic bifurcation, with an unknown primary, was made.