Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
Trauma Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):4169-4179. doi: 10.1007/s00068-022-01961-8. Epub 2022 Mar 31.
Intraoperative injury to the popliteal artery is a rare complication of orthopedic surgery, however, it can have serious consequences, including major amputation. Recommendations for a standard approach are lacking. The aim of this study was to develop an interdisciplinary therapeutic algorithm to assist in complication management.
From 01/11 to 12/20, 16 arterial injuries after knee surgery were analyzed in a retrospective single-center study. Four cases involved recurrent orthopedic surgery. Procedures performed included eleven total knee arthoplasties (TKA), two TKA replacements, one arthroscopy, and two high tibial osteotomies. Clinical presentation of patients was hemorrhage (n = 2), ischemia (n = 7), the combination of both (n = 4), or pseudoaneurysm formation (n = 3).
Ten patients underwent endovascular treatment, some as combined procedures: (stent)-PTA (n = 6), aspiration thrombectomy (n = 5), thrombin injection (n = 1), and embolization (n = 1). Six patients were treated surgically: four with bypass/interposition and one with a patch plasty and one as a hybrid procedure, respectively. Only autologous great saphenous vein was used. All extremities could be preserved. Functional impairment remained in six cases.
Both endovascular and surgical procedures can be used to treat arterial injuries after knee surgery. Efficient standardized diagnosis and the involvement of vascular expertise are essential to prevent functional impairment or limb loss, as suggested in the algorithms.
在矫形外科手术中，腘动脉损伤是一种罕见的并发症，但它可能会产生严重的后果，包括大截肢。目前缺乏关于标准治疗方法的建议。本研究旨在制定一种跨学科的治疗算法，以协助处理并发症。
在一项回顾性单中心研究中，分析了 2021 年 11 月 1 日至 2022 年 12 月 20 日期间 16 例膝关节手术后的动脉损伤。其中 4 例涉及反复矫形手术。手术包括 11 例全膝关节置换术（TKA）、2 例 TKA 翻修术、1 例关节镜检查术和 2 例胫骨高位截骨术。患者的临床表现为出血（n=2）、缺血（n=7）、两者兼有（n=4）或假性动脉瘤形成（n=3）。
10 例患者接受了血管内治疗，有些是联合治疗：（支架）-PTA（n=6）、抽吸血栓切除术（n=5）、凝血酶注射（n=1）和栓塞（n=1）。6 例患者接受了手术治疗：4 例采用旁路/间置术，1 例采用补片修补术，1 例采用杂交手术。仅使用自体大隐静脉。所有肢体均可保留。6 例患者仍存在功能障碍。
膝关节手术后的动脉损伤可以采用血管内和手术治疗。建议在算法中，高效的标准化诊断和血管专业知识的参与对于预防功能障碍或肢体丧失至关重要。
