The tale of two vessels, vascular complications following a breach of the pelvic inner table due to acetabular screws: a report of two cases
Khairul Anwar Ayob1, Azhar M. Merican1, Shahrul-Hisham Sulaiman2, Ahmad Rafizi Hariz Ramli3
1Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
2Department of Orthopaedic, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
3Department of Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
Keywords: Case report, complications, external iliac vein, inferior gluteal artery, total hip arthroplasty, vascular injury.
Abstract
Injuries to the pelvic vasculature during total hip arthroplasties are rare but have serious consequence. They demand urgent and early identification so that appropriate treatment can be instituted. If the bleeding is severe, cardiovascular compromise occurs intraoperatively and this will alert the surgeon of this possibility during acetabular screw placement. Alternatively, a delay in diagnosis can occur because the bleeding and the injured vessel are in the pelvic cavity and not visualized during the surgery. In this article, we report two cases from our center occurring within a six-month interval that sustained a vascular injury during acetabular drilling for screw placement for cementless cup fixation. Each case had a different vessel injury and different lessons can be learned from these rare injuries. The first case had an injury of the inferior gluteal artery following a breach of the sciatic notch. The vessel was treated with percutaneous embolization. The second case demonstrated a venous injury, following a medial protrusio technique for congenital hip dysplasia and a short anterosuperior screw, transecting the external iliac vein. This was subsequently repaired using an endovascular technique. We conclude the reasons for these vessel injuries after analyzing advanced imaging, discuss measures to avoid vessel injury and detail the minimally invasive method for their treatment.
Citation: Ayob KA, Merican AM, Sulaiman SH, Hariz Ramli AR. The tale of two vessels, vascular complications following a breach of the pelvic inner table due to acetabular screws: a report of two cases. Jt Dis Relat Surg 2021;32(1):239-244.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.