Minimally invasive intervention for acute bleeding from a pseudoaneurysm after revision hip arthroplasty.
After multiple revisions of her right hip arthroplasty, an 83-year-old woman developed deep infection with a chronic draining sinus. In August 2002 severe acute bleeding occurred through this fistula. Angiography revealed a pseudoaneurysm of the right external iliac artery. Because of the multiple pathologies affecting this ASA grade IV patient, conventional surgical treatment was considered to be contra-indicated, and a stent was placed percutaneously under fluoroscopic control to seal the vascular laceration. No haematoma and no further bleeding was observed on the control CT-scan or at angiography. However the patient died with terminal renal failure forty days later. The case reported shows a rare complication of total hip arthroplasty. The method used in this case to seal the leakage, using a covered stent, is uncommon but effective in cases where conventional surgery is contra-indicated.
Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, D-89081 Ulm, Germany. benjamin.ulmar@gmx.de
Benjamin
B
Ulmar
Andrik J
AJ
Aschoff
Karl-Heinz
KH
Orend
Wolfhart
W
Puhl
Klaus
K
Huch
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D021721:Balloon Occlusion / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007083:Iliac Artery; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000628:therapy; D012086:Reoperation; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome