Successful Conservative Treatment of an Acute Arterial Occlusion After Total Knee Arthroplasty: Report of 2 Cases and Review of the Literature

Abstract

BACKGROUND Acute arterial occlusion after total knee arthroplasty (TKA) is a rare but occasionally limb-threatening complication. Successful outcomes of surgical treatment for acute arterial occlusion after TKA have been frequently reported in the literature; however, few reports have described conservative treatment. This case report describes the successful conservative treatment of popliteal artery occlusion after TKA. CASE REPORT We report 2 cases of popliteal artery occlusion after TKA that were managed with conservative treatment. In Case 1, a 68-year-old woman presented with a weak dorsalis pedis pulse in the foot and weakness to dorsiflexion of the toe on the operative side immediately after TKA. The operative lower extremity arterial ultrasonography and computed tomography angiography demonstrated the popliteal artery occlusion. In Case 2, a 79-year-old woman presented a cold right foot and lack of popliteal and dorsalis pedis pulse in the operated extremity immediately after TKA, and Doppler ultrasound did not reveal a flow for the dorsalis pedis artery. In both patients, urgent angiographies showed popliteal artery occlusion, and blood flow was observable in the anterior tibial, peroneal, and foot arteries collateral perfusion. Thus, conservative treatments were chosen, and anticoagulant and vasodilator therapies were undergone in both patients. At 6 months after surgery, they were able to walk without intermittent claudication. CONCLUSIONS Conservative treatment can be a good option for popliteal artery occlusion after TKA in cases of rich collateral circulation.

Figure 1.

Preoperative radiograph of the right knee (Case 1), anteroposterior (A) and lateral (B) views.

Figure 2.

Postoperative radiograph of the right knee (Case 1), anteroposterior (A) and lateral (B) views.

Figure 3.

Angiography of the right knee showing occlusion of the popliteal artery with collateral perfusion of the anterior tibial artery, peroneal artery, and dorsalis pedis artery (Case 1); anteroposterior (A) and lateral (C) views of early phase showing occlusion of the popliteal artery (red arrow); anteroposterior (B) and lateral (D) views of late phase showing collateral perfusion of the anterior tibial artery and the peroneal artery (yellow arrow); and angiography of the right foot (E) showing the blood flow of the dorsalis pedis artery (blue arrow).

Figure 4.

Preoperative radiograph of the right knee (Case 2), anteroposterior (A) and lateral (B) views.

Figure 5.

Postoperative radiograph of the right knee (Case 2), anteroposterior (A) and lateral (B) views.

Figure 6.

Angiography of the right knee showing occlusion of the popliteal artery with collateral perfusion of the anterior tibial artery; the peroneal artery and medial plantar artery (Case 2); anteroposterior (A) and lateral (C) views of early phase showing occlusion of the popliteal artery (red arrow); anteroposterior (B) and lateral (D) views of late phase showing collateral perfusion of the anterior tibial artery and peroneal artery (yellow arrow); and angiography of the right foot (E) showing the blood flow of the medial plantar artery (blue arrow).