title: Significance of preoperative 3D-CT angiography for localization of the femoral artery in complicated THA.
abstract: BACKGROUND
  Major vascular injury is one of the most devastating complications in total hip arthroplasty (THA). Risk for intraoperative vascular injury is increased when the normal vascular anatomy is distorted by previous surgery or dislocation with displacement. Therefore, an appreciation of the vascular anatomy in relation to the anticipated surgical field is critical to avoid this complication during preoperative assessment for a complicated THA.
  
  
  METHODS
  Preoperative three-dimensional (3D) CT angiography was performed for 24 complicated THAs when altered vascular anatomy around the acetabulum was suspected. When assessing the CT images, the presence of apparent proliferation of vessels close to the original acetabulum as well as a distance of <10 mm from the artery to the acetabulum was deemed a potential risk factor for intraoperative vascular injury. Additionally, the relationships of clinical characteristics and the presence of these risk factors were analyzed to identify the patient population at risk.
  
  
  RESULTS
  The incidence of proliferation of collateral vessels was higher in patient groups with proximal femoral migration of 5 cm or more and multiple previous surgeries prior to the index THA. Moreover, in three ankylosed hips, lateral deviation of the main vascular trunk with an artery-acetabulum distance of <10 mm was identified in all cases.
  
  
  CONCLUSIONS
  Preoperative 3D-CT angiography in cases of complicated THA revealed altered vascular anatomy which may increase the risk for intraoperative vascular injuries. Patient characteristics related to the risk for this complication were marked proximal femoral migration, multiple previous surgeries, and hip ankylosis. Preoperative image examination of the vascular anatomy is thought to help reduce the risk of inadvertent vascular injury in these complicated THA cases.
authors.affiliation: Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan, f9457@hyo-med.ac.jp.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Fukunishi
authors.forename: Shohei
authors.initials: S
authors.lastname: Okahisa
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Fukui
authors.forename: Shoji
authors.initials: S
authors.lastname: Nishio
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujihara
authors.forename: Yu
authors.initials: Y
authors.lastname: Takeda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshiya
mesh_terms: D000077:Acetabulum / Q000098:blood supply*; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D003097:Collateral Circulation; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000293:injuries; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D057772:Vascular System Injuries / Q000517:prevention & control*