Delayed vascular complications after orthopaedic surgery: A report of two cases and review of the literature

Abstract

Vascular complications from orthopaedic surgery can be devastating. Arteriovenous fistula (AVF) and pseudoaneurysm formation are possible from orthopaedic injuries as well as orthopaedic surgery. Limbthreatening complications of vascular malformation include ischaemia, ulceration, haemorrhage, and gangrene potentially requiring amputation. Although rare, these vascular malformations should remain on the differential diagnosis for any patient not following the typical postoperative course. When presented with these case, and repair is recommended, it should be coordinated between orthopaedic and vascular surgeons. Review of the literature indicates that the risk of AVF and pseudoaneurysm formation remains underappreciated, particularly in the subacute and chronic setting. Theoretically, minimally invasive procedures with drilling near vessels increases the chances of vascular injury that goes unnoticed during the index procedure. This report of two cases discusses diagnosis and repair of pseudoaneurysm and AVF. It is a cautionary warning to consider these vascular injuries as late-presenting, limbthreatening complications of orthopaedic surgery.