Acute Arterial Embolization Following Total Knee Arthroplasty: A Report of Two Cases and Literature Review

Abstract

AbstractAcute arterial embolization is a rare but serious complication following total knee arthroplasty (TKA). So far, the general consensus for this situation is that revascularization must be performed immediately, but the specific treatment is still controversial. We report two cases of popliteal artery (PA) embolization caused by acute arterial thrombosis following TKA. Both patients suffered the loss of sensation and movement of the right lower limb and disappearance of dorsalis pedis artery pulsation after operation. Angiography showed PA embolization. One of the patients received thrombolytic therapy, but he developed a large area of infection and necrosis of the right calf muscle and required multiple debridement and skin grafting procedures after successful thrombolysis. The other patient underwent thrombectomy, vascular reconstruction, and prophylactic fasciotomy, and some foot numbness and slight extensor weakness remained after the operation. The authors suggest that surgeons should pay adequate attention to high-risk patients with TKA. Medical history and physical examination should be carefully collected before operation. The surgical procedure should be performed accurately and gently, and limb sensation and blood circulation should be carefully observed after operation. If foot sensation is abnormal and arterial pulsation is weakened, necessary examinations (Doppler ultrasound and arteriography) should be carried out immediately. Once diagnosed with arterial thrombosis, the blood supply should be restored immediately. If the diagnosis is delayed for more than 6 hours, prophylactic fasciotomy may be required as a treatment to avoid adverse consequences.