A Suspected Case of Adhesion to the Iliac Vein During the Left Femoral Arthroplasty

TL;DR

A patient had suspected vascular injury during hip surgery, but no intervention was needed after careful monitoring and tests.

Contribution

Highlights a multidisciplinary approach to managing potential vascular injuries during orthopedic surgery.

Findings

Suspected vascular injury occurred during acetabular cup insertion but was not confirmed.

Comprehensive imaging and tests allowed safe completion of surgery without vascular intervention.

Multidisciplinary preparation is crucial for managing high-risk orthopedic cases.

Abstract

An 85-year-old man underwent hemiarthroplasty for a left intertrochanteric femoral fracture at another hospital two years prior. While under outpatient monitoring, the left femur displacement occurred. Therefore, total hip arthroplasty of the left hip was scheduled. However, during acetabular cup insertion damage to the inner plate led to a sudden decrease in blood pressure from 120 to 60 mmHg. The physicians suspected a pelvic vascular injury and promptly stopped the procedure. In case of adhesion between the acetabular cup and the left iliac vein, intraoperative vascular damage would be repaired via endovascular intervention. Subsequently, orthopedic surgery was cautiously performed, taking into account the potential of a vascular injury. The surgery proceeded as planned without vascular intervention. This case involved a patient with suspected injury to the iliac vein and artery during acetabular cup placement. Following comprehensive enhanced CT and angiography tests, orthopedic surgery was performed in preparation for potential vascular damage, demonstrating the multidisciplinary approach to managing such cases.

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