Arterial Injuries in Total Knee Arthroplasty

Abstract

In total knee arthroplasty (TKA), arterial system is injured during surgery and misdiagnosis of this complication can be catastrophic. Its estimated incidence is of 0.08–0.5%. They suppose one of the worst complications in a TKA, with catastrophizing consequences, including compartment syndrome and amputation. Although it is decreasing with new diagnostic and therapeutical techniques, it has been communicated a mortality rate of 7% and amputation of up to 41%. There are four main clinical syndromes related to arterial complications in TKA needing vascular surgeon implication: acute ischemia, hemorrhage, ischemia with hemorrhage, and pseudoaneurysm formation. The most common location for vascular injuries in the context of a TKA is the popliteal artery. It can be injured by traction or direct trauma with surgical instruments. Superficial femoral artery can be injured as well, but in this case by tourniquet application, causing a dissection of intimal flap. It is paramount to check the vascular status of the limb after tourniquet deflation. If we are not aware of the possibility of these complications, diagnosis can be delayed with catastrophic consequences. Arteriography remains as the gold standard to detect arterial injuries. Endovascular techniques are preferred over open techniques for the treatment of arterial injuries. These techniques include diagnostic techniques (i.e., arteriography), contention techniques (i.e., endovascular balloon for stopping distal hemorrhage), and revascularization techniques (i.e., endovascular prosthesis, stent, coils).