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Review
. 2008 Mar;466(3):749-53.
doi: 10.1007/s11999-007-0109-z. Epub 2008 Jan 10.

Case report: superficial femoral artery injury resulting from cerclage wiring during revision THA

Thomas Aleto  1 , Merrill A Ritter, Michael E Berend
Affiliations
Review

Case report: superficial femoral artery injury resulting from cerclage wiring during revision THA

Thomas Aleto et al. Clin Orthop Relat Res. 2008 Mar.

Abstract

Vascular injuries around the hip are uncommon with hip arthroplasty. However, given the close proximity of the external iliac and femoral vessels to the hip, iatrogenic injury may occur. We describe a case of superficial femoral artery injury occurring during revision THA using an extended trochanteric osteotomy, bulk allograft, and cerclage wires. We review the available literature on vascular injury in hip arthroplasty and illustrate the great care necessary when placing cerclage wires and the importance of prompt recognition of these potentially devastating complications.

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Figures

Fig. 1
Fig. 1
A preoperative anteroposterior radiograph of the pelvis shows a well-fixed cemented acetabular component and a loose subsided cemented femoral stem with a healed trochanteric osteotomy.
Fig. 2A–B
Fig. 2A–B
Intraoperative arteriograms of the left lower extremity show (A) the superficial femoral artery obstruction before removal of the thrombus (arrow) and (B) the occlusion of the artery at the distal-most cerclage wire after thrombus removal (arrow).
Fig. 3A–B
Fig. 3A–B
An intraoperative angiogram shows (A) the cerclage wire before removal around the femoral artery (arrow). (B) After endovascular stent placement the occlusion of the superficial femoral artery is now relieved and normal distal runoff has been restored.
Fig. 4
Fig. 4
An anteroposterior femoral radiograph taken 2 months postoperatively shows the endovascular stent (arrow) and its proximity to the medially placed strut allograft.
Fig. 5A–C
Fig. 5A–C
Great care is necessary when passing cerclage wires around the femur, particularly when using strut allografts. The cerclage wires should be placed around the femur first and then passed around the strut grafts to protect the nearby neurovascular structure. (A) A photograph shows the wire passer used in our case. (B) A lateral view shows the cerclage wires around the strut graft. Care should be taken at the distal extent of the wound where the neurovascular bundle is closest to the femur. (C) A cross section shows the proximity of the wire passer to the neurovascular bundle after strut application.
See this image and copyright information in PMC

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