1. Case report: Popliteal artery pseudoaneurysm with arterio-venous fistula after total knee replacement MD, PhD student Leonid Magnitskiy; MD, PhD, Prof. Maxim Kuznetsov Pirogov Russian National Research Medical University (RNRMU), Department of faculty surgery №1, Moscow, Russia
Introduction
Preoperative angiography confirmed the large pseudoaneurism connected with popliteal vein with signs of stealing run-off vessels.
Epidural anesthesia
Prone position
Pseudoaneurysm 7x5 cm was resected
The connection between artery and vein was found and removed
End-to-end anastomosis of popliteal artery and vein was successfully performed
The thickening and induration of the vein wall was documented
Runoff vessels were actually patent
Duration of surgery - 3,5 hours
The incidence of arterial complications after total knee replacement ranges from 0.017% to 0.23%, and approximately 5.67 per 10,000 cases.
The annual number of total knee arthroplasty is increasing all over the world.
Case report
A 70-year-old female
3 years after total knee arthroplasty
Past medical history of hypertension, myocardial infarction and diabetes
BUT no previous history of peripheral artery disease
Increasing sizes of pseudoaneurism was demonstrated during Doppler study.
Chronic venous insufficiency: leg swelling, lipodermatosclerosis with circulate zone of hyperpigmentaion on the left calf (C4b).
Chronic arterial insufficiency: claudication after less than meters of walking.
Auscultation: pansystolic noise detected from popliteal region to groin area.
Femoral, popliteal pulses were palpable, but distal pulses were absent, Doppler ankle signals were weak and of low amplitude.
After surgery
Distal pulses became palpable
Low molecular weight heparin in therapeutic dosage - 7 days
Occlusive thrombosis of popliteal vein was diagnosed on the 3 day
Discharged from the hospital on 7 day after vascular surgery with prescriptions taking Rivaroxaban 20 mg once a day 3 months
No further arterial complications
No any venous thromboemolism events
12 months after treatment - good pulses and perfusion to the foot, leg swelling regressed, walking any distance without intermittent claudication
Procedure