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[血管损伤作为膝关节镜手术的并发症。两例报告并文献复习]

[Vascular injury as a complication of knee arthroscopic surgery. Report of two cases and review of the literature].

作者信息

Enríquez-Vega María Elizabeth, Cruz-Castillo Juan Ernesto, Pacheco-Pittaluga Ernesto, Solorio-Rosette Hugo, Linarte-Márquez Lizbeth, Iturburu-Enríquez Alessandra

机构信息

Servicio de Angiología y Cirugía Vascular, Hospital de Especialidades, Centro Médico La Raza, IMSS, Mexico DF, Mexico.

Hospital Español, Instituto de Beneficencia Española. México DF. Mexico.

出版信息

Cir Cir. 2013 Sep-Oct;81(5):454-8.

Abstract

BACKGROUND

Arthroscopy of the knee is a surgical performed world-wide considered extremely safe, rates of complication ranging from 0.56 to 8.2%. Vascular complications are even more rare (0.0032%), and generally related to the popliteal artery injury.

CLINICAL CASE

We are reporting the cases of two patients who had unsuspected vascular complications after arthroscopy. Both cases presented vascular injuries after elective knee arthroscopy. First case was a patient with thrombosed pseudoaneurysm in the popliteal artery and total section of the popliteal vein, unfortunately the diagnosis was done 72 hrs after knee arthroscopy and finally required amputation, the 2nd case presented popliteal arteriovenous fistula, the diagnosis was done 3 weeks after knee arthroscopy, the patient was successfully treated by resection of the fistula and direct repair of the artery and vein.

CONCLUSIONS

Although extremely infrequent, the vascular injury after knee arthroscopy should be remembered as a surgical complication, a low index of suspicion may have caused an unfortunate and untimely delay in diagnosis and treatment with potential risk of leg amputation and death.

摘要

背景

膝关节镜检查是一种在全球范围内开展的手术,被认为极其安全,并发症发生率在0.56%至8.2%之间。血管并发症更为罕见(0.0032%),且一般与腘动脉损伤有关。

临床病例

我们报告了两例在关节镜检查后出现意外血管并发症的患者病例。两例均在择期膝关节镜检查后出现血管损伤。第一例患者腘动脉有血栓形成的假性动脉瘤,腘静脉完全离断,不幸的是在膝关节镜检查72小时后才做出诊断,最终需要截肢;第二例患者出现腘动静脉瘘,在膝关节镜检查3周后做出诊断,患者通过瘘管切除及动静脉直接修复成功治愈。

结论

尽管膝关节镜检查后血管损伤极为罕见,但仍应作为一种手术并发症被铭记,低怀疑指数可能导致诊断和治疗的不幸且不合时宜的延误,存在腿部截肢和死亡的潜在风险。

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