Role of endovascular treatment in acute limb ischemia due to vascular occlusions following total knee replacement (TKR): a tertiary centre experience with review of literature

Congress:

ECR 2019

Poster Number:

C-1074

Type:

Scientific Exhibit

Keywords:

Arteries / Aorta, Artificial Intelligence, Interventional vascular, Catheter arteriography, CT-Angiography, MR, Thrombolysis, Angioplasty, Catheters, Aneurysms, Blood, Embolism / Thrombosis

Authors:

L. S. P. Karanam, S. R. BADDAM, N. R. Busireddy, R. Polavarapu, V. Pamidimukkala; Guntur/IN

DOI:

10.26044/ecr2019/C-1074

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1074

Fig. 1: 69 year old female presented with acute limb ischemia following TKA.Scout film...

Fig. 2: catheter angiogram showing no filling from the distal superficial femoral...

Fig. 3: 72 year old female presented with acute limb and plain x ray showing the...

Fig. 4: Post procedure digital subtraction angiogram images showing the recanalised...

Aims and objectives

Vascular injury following Total knee replacement (TKR) is extremely rare with a reported incidence of 0.03 to 0.17%.Popliteal artery occlusion after total knee replacement is a rare complication with direct injury being the most common cause.We present a series of 14 patients who underwent endovascular recanalisation for acute thrombotic occlusion following TKR referred to our center.

Methods and materials

A total of 14(9 female and 5 male) patients presented with acute limb following TKR to us from April 2013 to march 2018. Preliminary bed side Doppler is done in all the patients which identified the occlusion in these cases.One patient, 64 year male who underwent unilateral TKR, presented on 3rd post operative day (late onset) with pulselessness, paresthesias and changes of early ischemia in the toes. All the patients underwent CT angiogram and shifted immediately to cath suite. The patient who presented with late...

Results

Successful recanalisation with good distal ante grade flow is established in all the cases.One patient who presented with late onset despite good recanalisation underwent ray amputation. None of the patients required any adjuvant vascular surgical procedure for the thrombotic occlusion and endovascular technique achieved good outcomes in all the cases.Prompt detection with early intervention is the reason for successful clinical outcome in 90% of the patients. We did not have any mortality because of this complication in our series.

Conclusion

Vascular injury is a rare but devastating complication of TKA causing limb loss and mortality. High degree of suspicion is required for early diagnosis and multidisciplinary approach is the key for successful outcome in such cases.

Personal information

References

1. K.D. Calligaro, M.J. Dougherty, S. Ryan, et al., Acute arterial complications associated with total hip and knee arthroplasty, J Vasc Surg 38, 2003, 1170e1177. 2. M.S. Da Silva and M. Sobel, Popliteal vascular injury during total knee arthroplasty, J Surg Res 109, 2003, 170–174. 3. J.S. Wilson, A. Miranda, B.L. Johnson, M.L. Shames, M.R. Back and D.F. Bandyk, Vas-cular injuries associated with elective orthopedic procedures, Ann Vasc Surg 17, 2003, 641–644. 4. S. Khan, Popliteal artery occlusion after total knee replacement: a vascular team...