Endovascular repair of external iliac artery occlusion after hip prosthesis migration.
OBJECTIVE
To report emergent endovascular intervention to restore lower extremity arterial patency after migration of a hip prosthesis caused thrombosis of the external iliac artery (EIA).


METHODS
Nine months following left hip revision arthroplasty, a 66-year-old woman presented to the Emergency Department with the complaints of an acutely painful left lower extremity for over 6 hours. Imaging showed the metallic acetabular portion of the hip prosthesis in the iliac fossa, with severe external compression of the EIA. After thrombolysis to remove clot from the EIA, an 8x60-mm self-expanding Smart stent was deployed in the left EIA from a contralateral access. The procedure was successful, and the patient was discharged. An infected wound from a compartment fasciotomy delayed revision of the hip prosthesis. Nine weeks after stenting, the patient returned with a cold, pulseless left limb; a femorofemoral bypass was constructed to restore perfusion.


CONCLUSIONS
While stent placement restored flow for 9 weeks after the initial ischemic event, the recurrent thrombosis could have been prevented by earlier revision of the migrated prosthesis.
Kwolek
Christopher J
CJ
Department of Surgery, Vascular Section, University of Kentucky, Lexington, Kentucky, USA. ckwolek@partners.org
Matthews
Marc R
MR
Hartford
James M
JM
Minion
David J
DJ
Schwarcz
Thomas H
TH
Quick
Rhonda
R
Endean
Eric
E
D000368:Aged; D017130:Angioplasty; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications*; D006622:Hip Prosthesis; D006801:Humans; D007083:Iliac Artery; D011475:Prosthesis Failure; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*