Wilson Jeffrey S, Miranda Ana, Johnson Brad L, Shames Murray L, Back Martin R, Bandyk Dennis F
Division of Vascular and Endovascular Surgery, University of South Florida College of Medicine, Tampa, FL, USA.
Ann Vasc Surg. 2003 Nov;17(6):641-4. doi: 10.1007/s10016-003-0074-2. Epub 2003 Oct 13.
The objective of this study was to review the diagnosis, management, and outcome of the rare iatrogenic arterial injury associated with elective orthopedic joint procedures. A retrospective review was conducted of all patients presenting to the vascular surgery service with arterial injury after elective orthopedic procedures between 1997 and 2002. Clinical records were reviewed for presentation, type of injury, management, and outcome. During the study period, 20 patients having 21 total orthopedic procedures were identified with 27 arterial injuries. There were 4350 elective orthopedic procedures during this period for an incidence of 0.005%. There were 14 total knee arthroplasties, 4 total hip arthroplasties, and 3 ankle reconstructions in the study group. Presenting signs included acute ischemia with loss-of-limb Doppler-detected arterial flow/pulses (13 patients, 62%), intraoperative arterial bleeding (3 patients, 14%), nonhealing wounds (3 patients, 14%), and limb edema (2 patients, 10%); the diagnosis was delayed >24 hr in 5 patients (25%). Arterial thrombosis was the most common abnormality identified (21 of 27 injuries, 78%), followed by laceration/avulsion (3 injuries, 11%) and pseudoaneurysm development (3 patients, 11%), and involved the iliac ( n = 3), common femoral ( n = 2), profunda ( n = 1), superficial femoral ( n = 4), popliteal ( n = 12), or tibial ( n = 5) arteries. Concomitant popliteal venous injury was present in one patient. Injured arterial segments had preexisting atherosclerotic disease (33%) and 15 patients (71%) had prior surgery in proximity to the arterial injury while an additional 9 (43%) had prior traumatic injury (7 [78%] of whom had revision orthopedic surgery as well). Management consisted of vein bypass grafting ( n = 15, 56%), primary repair ( n = 3, 11%), and thrombectomy with thrombolysis ( n = 2, 7%). One patient (5%) underwent primary above-knee amputation. There was one death from septic shock and there were three limb losses (14%). Arterial injury associated with elective orthopedic joint surgery is more common during redoprocedures and in patients with preexisting atherosclerosis. Despite arterial repair/bypass, limb morbidity is common and related to preexisting occlusive disease or extent of arterial thrombosis.
本研究的目的是回顾与择期骨科关节手术相关的罕见医源性动脉损伤的诊断、处理及结果。对1997年至2002年间因择期骨科手术后出现动脉损伤而就诊于血管外科的所有患者进行了回顾性研究。查阅临床记录以了解其临床表现、损伤类型、处理方式及结果。在研究期间，确定20例患者共接受了21次骨科手术，发生了27处动脉损伤。在此期间共进行了4350例择期骨科手术，发生率为0.005%。研究组中有14例全膝关节置换术、4例全髋关节置换术和3例踝关节重建术。临床表现包括急性缺血伴肢体多普勒检测到的动脉血流/搏动消失（13例患者，62%）、术中动脉出血（3例患者，14%）、伤口不愈合（3例患者，14%）和肢体水肿（2例患者，10%）；5例患者（25%）诊断延迟超过24小时。动脉血栓形成是最常见的异常情况（27处损伤中的21处，78%），其次是撕裂/撕脱伤（3处损伤，11%）和假性动脉瘤形成（3例患者，11%），累及髂动脉（n = 3）、股总动脉（n = 2）、股深动脉（n = 1）、股浅动脉（n = 4）、腘动脉（n = 12）或胫动脉（n = 5）。1例患者伴有腘静脉损伤。受损动脉节段存在既往动脉粥样硬化疾病（33%），15例患者（71%）在动脉损伤附近有既往手术史，另外9例（43%）有既往外伤史（其中7例[78%]也接受了骨科翻修手术）。处理方式包括静脉搭桥术（n = 15，56%）、一期修复（n = 3，11%）以及血栓切除术联合溶栓治疗（n = 2，7%）。1例患者（5%）接受了一期膝上截肢术。有1例患者死于感染性休克，3例患者肢体丧失（14%）。与择期骨科关节手术相关的动脉损伤在翻修手术及有既往动脉粥样硬化的患者中更为常见。尽管进行了动脉修复/搭桥术，但肢体并发症仍很常见，且与既往闭塞性疾病或动脉血栓形成的范围有关。
