Vascular complications of orthopedic surgery: an update on diagnosis and management

Vascular complications in orthopaedic surgery are not fre- quent, but they can be severe and occasionally life-threatening. Present technologies make it easier to detect and successfully manage them, provided a high level of clin- ical suspicion is kept. Spontaneous complication is deep venous throm- bosis (DVT), which occurs in 2.5% of patients undergoing hip or knee arthroplasty and can be treated by prophylactic doses of low molecu- lar weight heparin (LMWH). D-Dimer blood test and duplex scanning are the pillars of diagno- sis. LMWH (6000 U twice daily) is standard therapy but in selected cases thrombolysis or surgical venous thrombectomy can be used. Iatrogenic complications come from surgical manoeuvres and instruments; risk factors are preex- isting atheromatous lesions and reinterventions, both orthopaedic and vascular. These lesions can cause bleeding, ischaemia, embolism, pseudoaneurysms or arteriovenous fistula, and are classi- fied accordingly. Diagnosis is done by duplex scanning, computed tomography or angiography (partic- ularly intraoperative angiography) and should be timely in order to allow the earliest possible manage- ment. This is crucial for a success- ful result, which may avoid damage to the patient and medicolegal problems. District-specific compli- cations and treatment are reviewed.