Pseudoaneurisma de la arteria poplítea como complicación de la cirugía de prótesis de rodilla: tratamiento endovascular

Introduction. Vascular complications as a consequence of knee surgery are rare, but can result in a high rate of morbidity. Case report. A 71-year-old female with obesity and hypertension who visited the Emergency department two weeks after a total arthroplasty on her right knee because of persistent pain, oedema and haematoma in the right calf. Examination revealed a hard oedema in the right lower limb, with a haematoma in the popliteal fossa and calf, and an expansive popliteal pulse. Arterial and venous Doppler ultrasound recording was performed on the right lower limb and results showed a pseudoaneurysm of the popliteal artery associated with thrombosis of the popliteal vein. Urgent treatment was established by an ipsilateral femoral approach, arteriography and placement of a covered stent. Immediate arteriographic control: exclusion of the pseudoaneurysm with patency of the covered stent. The patient was put on anticoagulant therapy for three months as treatment for the associated popliteal vein thrombosis. Oral anticoagulation therapy was later withdrawn and treatment continued with antiaggregating agents. Follow-up with Doppler ultrasound showed primary patency of the covered stent at 12 months, and the patient was capable of bending the right knee through 120°. Conclusions. The presence of vascular lesions after knee arthroplasty surgery must always be considered in the presence of persistent haematoma, pain and oedema of the popliteal fossa. Treatment using covered stents makes it possible to minimise the complications associated with surgical treatment, and thus represents a suitable short and medium-term alternative. [ANGIOLOGÍA 2008; 60: 49-54]