title: Hemorrhagic-Induced Cardiovascular Complications During Reamer-Irrigator-Aspirator-Assisted Femoral Nonunion Treatment.
abstract: The reamer-irrigator-aspirator (RIA) is a device that has recently been developed to retrieve bone graft from the medullary canal of the femur and the tibia. As for most new surgical procedures, complications arise as part of the learning curve and/or imperfections in the design or technique. To increase awareness of potential complications and to prevent unnecessary harm to the patient, new complications need to be reported. We present case reports of 2 patients who developed severe intraoperative cardiac events presumably caused by excessive and rapid blood loss during RIA bone graft harvesting. This complication has not been described before. Increased awareness of excessive blood loss and subsequent cardiac events during an RIA procedure is warranted.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Departments of *Orthopaedic Surgery, and †Anesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Johanna C E
authors.initials: JC
authors.lastname: Donders
authors.forename: Holger M
authors.initials: HM
authors.lastname: Baumann
authors.forename: Markus F
authors.initials: MF
authors.lastname: Stevens
authors.forename: Peter
authors.initials: P
authors.lastname: Kloen
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D003646:Debridement / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D017759:Fractures, Malunited / Q000175:diagnosis / Q000601:surgery*; D006470:Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000150:complications* / Q000175:diagnosis; D013396:Suction / Q000009:adverse effects; D007507:Therapeutic Irrigation / Q000009:adverse effects*; D016896:Treatment Outcome