Femoral Complications Research Articles

Vascular Access and Closure: Transradial Intervention, Femoral Closure Devices and Complication Management

Vascular Access and Closure: Transradial Intervention, Femoral Closure Devices and Complication Management

Femoral Fractures in Revision Hip Surgeries with Impacted Bone Allograft

Impacted allograft bone in hip revision arthroplasty is a biologic reconstruction method that restores bone loss. Periprosthetic femoral fracture is one of the most frequent complications. However, the incidence, types of fracture, time of occurrence, predisposing factors, and whether and how complication affects the reconstruction are unknown. We analyzed 285 femoral revisions performed with this technique. Fractures occurred in 64 patients (22.4%). Fifty-nine of these 64 incidents (92%) occurred during surgery and five within the first postoperative year. Of the 59 intraoperative lesions, 34 were fractures (57.6%) and 25 were incidental perforations (42.3%). Most fractures and incidental perforations were associated with cement removal rather than the reconstructive technique. The reconstruction was compromised in two of the 34 fractures, but the remainder healed without complications. Five patients had a diaphyseal fracture develop within the first postoperative year, four of whom had an intraoperative incidental perforation. There was an increased risk of fractures within the first postoperative year in patients who had an incidental perforation during surgery and in those with severe bone defects. Despite the high rate of femoral complications associated with this reconstructive technique, most did not influence the reconstruction and only the intraoperative and postoperative complete diaphyseal fractures underwent additional treatment.

“The Disappearing Patella”: an unusual sequel following total knee replacement

Patello femoral complications have been described following total knee replacement (TKR) surgery. Majority of the reports are on the position and the biomechanics across the patello femoral joint. An unusual finding which shows the patella to be gradually disappearing following a TKR has not been reported. We report this finding in a 74-year-old lady who underwent a right total knee replacement (TKR) 5 years ago. Check radio graphs taken at 2 years showed osteolysis and on follow up at 5 years the right patella has become very thin and appears to be disappearing. The right patella measured 17 mm (anterior posterior thickness) at time of surgery and now measures 4 mm. There is osteolysis adjacent to the tibial and femoral components. However, there are no features of infection and there is no history of trauma. The patient continues to be asymptomatic and mobilises with a normal pain free gait. This interesting and unusual sequel is being reported for its rarity. A similar finding following a TKR has not been cited in literature.

Collagen plug device-related femoral artery complication visualized by femoral angiography

A 65-year-old man was presented to our emergency room complaining of severe chest pain. Electrocardiogram and cardiac enzyme suggested acute anterior wall myocardial infarction, and the total occlusion of the left anterior descending coronary artery was recannalized via primary coronary intervention. Another critical stenosis was detected in the distal right coronary artery. We deployed a stent in the right coronary artery 5 days after the first procedure, and finished the procedure using a collagen plug device (Angioseal, DAIG). Both percutaneous coronary interventions were performed via right femoral arterial approach. The patient was discharged without complications with the exception of a 4 4 cm hematoma in the right groin. However, the patient complained of continuous right groin pain and purulent discharge from the puncture site one week after the second procedure. Therefore, we recommended him for admission again, began antibiotic treatment, and

Access-site complications after rescue percutaneous coronary intervention during thrombolysis for acute myocardial infarction

Aggressive antithrombotic medical therapy may increase the rate of access-site complications after percutaneous coronary intervention. Frequently, emergency coronary interventions have to be performed in a situation when thrombolysis therapy was administered as the first-line therapeutic approach in acute myocardial infarction but failed to achieve stable conditions. We analyzed the rate of femoral bleeding complications after emergency coronary intervention in 76 consecutive patients with unsuccessful thrombolysis in acute myocardial infarction. All invasive procedures were performed in a time period no longer than eight hours after thrombolysis was administered. Additional antithrombotic therapy with heparin and glycoprotein IIb/IIIa-inhibitors was given during intervention in 100% and 38.2% of patients, respectively. In three patients (3.9%) femoral hematomas without therapeutic consequences were documented; one patient (1.3%) developed a hematoma requiring blood transfusion. A pseudoaneurysm, fistula or surgical vascular intervention did not occur. Coronary interventional procedures in rescue situations can be performed with excellent safety with respect to access-site bleeding complications even under conditions of ongoing thrombolysis therapy and aggressive antithrombotic medical regimens.

Results of operative therapy of periprosthetic femur shaft fractures in total hip endoprostheses

Periprosthetic femoral shaft fracture represents an uncommon but potentially devastating complication associated with total hip arthroplasty. The treatment should result in complete union of the fracture and at the same time guarantee stability of the implant. 15 patients treated between 1992 to 1998 were analysed. Clinical and radiographic follow-up averaged 30 months (6-79 months) in 13 cases. Two patients died regardless of the fracture. The method of treatment depended on the intraoperative stability of the prosthesis and in addition on the fracture type (Bethea). In 5 cases of intraoperative stability of the prosthesis plate fixation was performed. Plate fixation was complicated by fixation failure combined with a recurrent fracture in two cases leading to shift to a long stem prosthesis. Ten cases of fractures associated with loose stems were treated with a new prosthesis using a long stem system. In these cases an uncomplicated healing of the fracture was achieved with adequate stability in radiographic examinations. The average Harris score was 70 (26-93). For fractures near the femoral stem or in case of implant loosening we recommend the shift to a long stem prosthesis. Also in fractures distally from the femoral stem tip we prefer now long stem implants rather than plate fixation to avoid large exposure of the femoral shaft and resultant complications.

Safety of femoral closure devices after percutaneous coronary interventions in the era of glycoprotein IIb/IIIa platelet blockade

We compared in-hospital femoral complications of Angio-Seal, Perclose, and manual compression in consecutive patients who underwent percutaneous coronary interventions in the era of glycoprotein IIb/IIIa platelet inhibition. Femoral closure devices have a similar overall risk profile as manual compression, even in patients treated with glycoprotein IIb/IIIa platelet inhibition, although certain rare complications such as retroperitoneal hemorrhage and severe access-site infection may be more common with the use of these devices.

Femoral Complications and Bed Rest Duration After Coronary Arteriography

This randomized study using a pneumatic compression device found no significant difference in the femoral complication rate between 4 and 6 hours of bed rest after Judkin's coronary arteriography. The positive implications for the organization of an efficient service in busy tertiary centers include reduced patient discomfort, earlier ambulation and discharge, efficient staff deployment, and enhanced throughput.

Comparison of 6F with 7F and 8F guiding catheters for elective coronary angioplasty: Results of a prospective, multicenter, randomized trial

A group of 460 patients was considered in our prospective study of assessment of the efficiency and safety of 6F (internal diameter 0.062 inches) guiding catheters to perform elective percutaneous coronary angioplasty by the femoral approach by using conventional balloon systems. The patients were randomly assigned either a 6F guiding catheter (first group, n = 231; 247 coronary lesions), or a 7F or 8F guiding catheter (second group, n = 229; 252 coronary lesions). The exclusion criteria were the ongoing myocardial infarction, the marked reduction of left ventricular function, and the decision to treat the lesion with a device not fitting the 6F guiding catheter. The angioplasty success rates (87% in the 6F group vs 88% in the 7F or 8F group) and the stent implantation rates (21% vs 25%) were similar in both groups. The ischemic complication rates (death, 2 vs 1) were also similar. The incidence of the femoral complications was significantly less important in the 6F group than in the 7/8F group (13.8% vs 23.5% p < 0.01). Significant differences also were noted for the procedural time (36 ± 22 vs 41 ± 28 min; p < 0.01), the fluoroscopy time (11 ± 10 vs 14 ± 4 min; p < 0.05), the volume of contrast injected (136 ± 68 ml vs 168 ± 95 ml; p < 0.0001), and the time of femoral compression after the introducer sheath removal (11.7 ± 9 vs 14.1 ± 12 min; p < 0.01). Our data suggest that 6F guiding catheters for elective coronary angioplasty are more effective than are the larger diameter catheters. Besides a significant decrease of vascular complications, angioplasty with a 6F guiding catheter reduces the procedural time and the amount of contrast. (Am Heart J 1997;134:131-137.)

Shorter Bed Rest and Femoral Complications after Cardiac Catheterisation: Less Strict, but Less Safe?

Shorter Bed Rest and Femoral Complications after Cardiac Catheterisation: Less Strict, but Less Safe?

Bipolar revisions with bone-grafting for cavitary and segmental acetabular defects: A minimum 5-year follow-up study

Bipolar revisions used in massive uncontained acetabular defects often lead to high migration rates and early clinical failure. Reconstructions for less severe acetabular bone deficiencies were studied radiographically and clinically. Thirty-two bipolar revisions with bone-grafting were performed for cavitary and segmental acetabular defects. The average follow-up period was 6 years (range, 5–8.4 years). Medial migration averaged 2.3 mm (range, 0–7 mm), oblique migration averaged 2.9 mm (range, 0–8 mm), and superior migration averaged 5.9 mm (range, 0–15 mm). Continued migration at the final follow-up evaluation was noted in all but nine hips. Arrested migration was observed when cavitary defects were encountered. Segmental medial wall defects resulted in increased medial migration. Segmental superior rim defects resulted in large amounts of superior migration. Preoperative Harris hip scores averaged 47 before surgery and 86 at the final follow-up evaluation. Postoperative clinical scores did not deteriorate with radiographic evidence of progressive migration. Six reoperations for femoral complications of fracture or loosening were performed at an average of 4.7 years with concomitant conversion of the bipolar prosthesis to a fixed cementless cup. One rerevision was performed for acetabular disassembly at 6.6 years. When cavitary defects exist, allografting with a bipolar endoprosthesis can provide durable reconstructions with excellent clinical function. Bipolar revisions are also a relatively simple means of providing stability in recurrent dislocation cases.

Peripheral vascular complications of coronary angioplasty by the femoral and brachial techniques

In order to monitor the incidence and types of peripheral vascular complications in a single institution, we prospectively entered 1,579 coronary angioplasty cases into a computer data base during the years 1991 and 1992. Various periprocedural risk factors were analyzed. The patients were followed closely to identify complications that occurred outside the laboratory or after discharge from the hospital. Peripheral vascular complications occurred in 37 patients (2.37%) and included hematoma 20 (1.27%), retroperitoneal bleeding 7 (.44%), false aneurysm 6 (.38%), occlusion 1 (.06%), infection 2 (.13%), and cholesterol emboli 1 (.06%). Risk factors for complications by multivariate analysis were older age, female gender, and clinical evidence of peripheral vascular disease. Other factors potentially related to vascular trauma or bleeding tendency that were not risk factors in this series were clinical presentation, use of heparin or thrombolytic agents, blood clotting parameters, and arterial sheath size. There was no significant difference between the femoral and brachial approaches in frequency of complications (2.5% vs. 1.6%), but femoral complications tended to carry greater morbidity.