Vascular complications of orthopaedic surgery: an update on diagnosis and management

Abstract

Vascular complications in orthopaedic surgery are not frequent, but they can be severe and occasionally life-threatening. Present technologies make it easier to detect and successfully manage them, provided a high level of clinical suspicion is kept. Spontaneous complication is deep venous thrombosis (DVT), which occurs in 2.5% of patients undergoing hip or knee arthroplasty and can be treated by prophylactic doses of low molecular weight heparin (LMWH). D-Dimer blood test and duplex scanning are the pillars of diagnosis. LMWH (6000 U twice daily) is standard therapy but in selected cases thrombolysis or surgical venous thrombectomy can be used. Iatrogenic complications come from surgical manoeuvres and instruments; risk factors are preexisting atheromatous lesions and reinterventions, both orthopaedic and vascular. These lesions can cause bleeding, ischaemia, embolism, pseudoaneurysms or arteriovenous fistula, and are classified accordingly. Diagnosis is done by duplex scanning, computed tomography or angiography (particularly intraoperative angiography) and should be timely in order to allow the earliest possible management. This is crucial for a successful result, which may avoid damage to the patient and medicolegal problems. District-specific complications and treatment are reviewed.