Acute thrombotic occlusion after total knee arthroplasty: Role of endovascular management

Abstract

Aim: Acute arterial occlusions after total knee arthroplasty (TKA) are rare but very serious complication. We present a series of 9 patients who underwent endovascular recanalisation for acute thrombotic occlusion following TKA in our institution. The present series determine the importance of early diagnosis and role of early intervention for good clinical outcome in these cases.

Methods: From 2013 to 2016, a total of 9 patients (3 male and 6 female) presented with acute popliteal thrombosis following TKA. All the patients underwent endovascular procedure. Clinical presentation, procedural details and clinical outcome was discussed.

Results: Technical success is achieved in all the cases. A combination of clot lysis, thromboaspiration and balloon angioplasty was used. 8 patients had successful clinical outcome. One patient underwent amputation despite good recanalisation.

Conclusion: High degree suspicion with careful monitoring in the postoperative period is needed to identify the problem at the earliest, and early diagnosis with recanalisation within 6 h is the key to limb salvage in these patients.

Fig. 1

69 year old female presented with acute limb ischemia following TKA. Scout film showing the implant on the right side (arrows in A). CT angiogram on sagittal plane showing the occlusion of right popliteal artery (arrow in B). Catheter angiogram showing no filling from the distal superficial femoral artery (arrow in C). Under road map guidance catheter reached the thrombus (arrow in D). Post procedure angiogram showing the recanalised artery at the level of the implant (arrow in E) and at the bifurcation (arrowin F). Good ante grade flow is seen till the ankle joint (arrow in G).

Fig. 2

72 year old female presented with acute limb and plain x ray showing the bilateral implants of the knee (arrow in A). Catheter angiogram showing the occlusion of the left distal SFA with no distal flow (arrow in B). Glide catheter is placed in the clot (arrow in C) and lysis given followed by angioplasty with 5 × 100 (arrow in D) balloon. Post procedure digital subtraction angiogram images showing the recanalised popliteal artery (arrow in E) with good trifurcation (arrow in F) and antegrade flow till the ankle (arrow in G).