Anticoagulation therapy for postoperative deep vein thrombosis coupled with pulmonary embolism: a potential trigger for delayed popliteal artery injury presentation after total knee arthroplasty.

A case of delayed popliteal artery injury (PA-INJ) onset after total knee arthroplasty (TKA) in a patient under postoperative anticoagulation therapy is reported. The role of anticoagulation both in late PA-INJ presentation and in PA-INJ management is discussed. An obese 76-year-old woman was presented with a common femoral vein thrombosis coupled with pulmonary embolism five days after TKA. She was immediately placed under anticoagulation therapy. Four days later, during physiotherapy-supervised mobilization, she developed a calf haematoma and large retro-articular pseudoaneurysm. Angiography revealed a minor PA-INJ successively treated with a covered stent-graft. In cases of initially undetected and staunched TKA-related PA-INJs, postoperative anticoagulation therapy may act as a potential trigger for final arterial rupture during mobilization exercises, followed by acute bleeding; in these cases, endovascular management represents an excellent treatment option. Close clinical and instrumental monitoring is strongly recommended after TKA, in patients who imperatively require full-dose anticoagulation therapy.

Citation

F De Santis, G Martini, T Haglmüller, G Mani, C Conati, G Bonatti. Anticoagulation therapy for postoperative deep vein thrombosis coupled with pulmonary embolism: a potential trigger for delayed popliteal artery injury presentation after total knee arthroplasty. Phlebology / Venous Forum of the Royal Society of Medicine. 2013 Aug;28(5):275-7

PMID: 22865417

search → result