title: Endovascular embolisation is a successful and safe treatment for post-operative arterial complications after total hip arthroplasty and revision surgery.
abstract: Arterial complications are rare but clinically critical during or following total hip arthroplasty (THA) surgery. They usually require secondary interventions, either through open or endovascular approaches. In a retrospective study, we analysed indications for, as well as success and safety of, endovascular embolisation for arterial complications after THA.
  
  
  
  We reviewed all arterial complications that had occurred through THA surgery and been treated by endovascular embolisation. We analysed angiographic findings, endovascular treatment, location in relation to the surgical approach and success of the interventions.
  
  
  
  Between 1997 and 2013 we performed 3,891 THAs at our hospital. We identified 14 patients with acute arterial complications treated by minimally invasive endovascular embolisation. Clinical findings included swelling of the ipsilateral leg, pain, prolonged wound bleeding, decreased haemoglobin and/or haemodynamic instability. Angiography revealed pseudoaneurysm in 11 patients, arteriovenous fistulas in two and extravasation of contrast media in one. Two patients showed no signs of acute bleeding. Twelve patients were treated, each with a single session of endovascular embolisation; in two additional patients, the haematoma was evacuated. No complications from the endovascular treatment were observed in this series.
  
  
  
  Endovascular embolisation is a safe and successful minimally-invasive method to treat arterial injuries occurring through THA. Therefore, it should be considered as a first-line option of treatment for those injuries.
authors.affiliation: Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. Matthias.Erschbamer@gmail.com.
authors.forename: Matthias
authors.initials: M
authors.lastname: Erschbamer
authors.affiliation: Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Den Hollander
authors.affiliation: Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sauter
authors.affiliation: Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Erhardt
authors.affiliation: Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Hechelhammer
authors.affiliation: Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Külling
mesh_terms: D000792:Angiography; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004621:Embolization, Therapeutic; D006801:Humans; D011183:Postoperative Complications / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Arterial complication; Endovascular embolisation; Hip surgery