title: Anticoagulation therapy for postoperative deep vein thrombosis coupled with pulmonary embolism: a potential trigger for delayed popliteal artery injury presentation after total knee arthroplasty.
abstract: OBJECTIVE
  A case of delayed popliteal artery injury (PA-INJ) onset after total knee arthroplasty (TKA) in a patient under postoperative anticoagulation therapy is reported. The role of anticoagulation both in late PA-INJ presentation and in PA-INJ management is discussed.
  
  
  METHODS
  An obese 76-year-old woman was presented with a common femoral vein thrombosis coupled with pulmonary embolism five days after TKA. She was immediately placed under anticoagulation therapy. Four days later, during physiotherapy-supervised mobilization, she developed a calf haematoma and large retro-articular pseudoaneurysm. Angiography revealed a minor PA-INJ successively treated with a covered stent-graft.
  
  
  CONCLUSIONS
  In cases of initially undetected and staunched TKA-related PA-INJs, postoperative anticoagulation therapy may act as a potential trigger for final arterial rupture during mobilization exercises, followed by acute bleeding; in these cases, endovascular management represents an excellent treatment option. Close clinical and instrumental monitoring is strongly recommended after TKA, in patients who imperatively require full-dose anticoagulation therapy.
authors.affiliation: Department of Vascular Surgery, Bressanone Hospital, Bressanone, Italy. f.desantis6@virgilio.it
authors.forename: F
authors.initials: F
authors.lastname: De Santis
authors.forename: G
authors.initials: G
authors.lastname: Martini
authors.forename: T
authors.initials: T
authors.lastname: Haglmüller
authors.forename: G
authors.initials: G
authors.lastname: Mani
authors.forename: C
authors.initials: C
authors.lastname: Conati
authors.forename: G
authors.initials: G
authors.lastname: Bonatti
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D009765:Obesity / Q000150:complications; D011150:Popliteal Artery / Q000293:injuries*; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000925:Anticoagulants