P030: ANESTHETIC MANAGEMENT OF FEMORAL ARTERY INJURY DURING TOTAL HIP ARTHROPLASTY RESULTING IN MASSIVE HEMORRHAGE AND COMPARTMENT SYNDROME.
Evan Maisel, MD1; Madina Akhmetkaliyeva, MD1; Samridhi Laroia, MD2; 1HCA Florida Kendall Hospital; 2HCA Florida Aventura Hospital
Introduction: Hip surgery is a standard surgical procedure and is widely considered to be safe. Even with a high success rate and experienced surgeons, complications can occur. This report aims to discuss the unexpected injury to the common femoral artery during total hip replacement and highlight the severity of this injury, complications associated with massive hemorrhage, and the measures taken to address it.
Methods: The patient is a 43-year-old male with a history of diabetes and morbid obesity who presented to the hospital for total hip replacement surgery due to degenerative joint disease. The surgery went uneventfully until reduction of the hip back into the socket was required. As the surgeon had difficulty manipulating around unanticipated tissue overlying the socket, an incidental slippage of instrumentation that was attempting to aid in retracting the tissue caused a traumatic injury to the right common femoral artery. This catastrophic event resulted in almost immediate massive blood loss and hemodynamic instability. Second, insufficient blood supply to the distal leg caused ischemic compartment syndrome with neurologic deficiency.
Results: The Anesthesia team immediately activated the facility’s massive transfusion protocol, established central access, and started resuscitation with crystalloids and vasopressors until blood products arrived. Vascular surgery and interventional radiology successfully repaired the injured vessel and re established adequate blood flow to the distal extremity. Subsequently, compartment syndrome occurred, which was promptly recognized, leading to fasciotomy being performed.
Discussion/Conclusion: Injuries to the femoral artery during hip surgery are rare but potentially disastrous complications. The severity of the injury can lead to massive hemorrhage requiring significant administration of blood products and prevention of coagulopathy. Prompt recognition and intervention by both the anesthesia and surgical team are crucial to minimizing the risk of complications and improving patient outcomes. Post-operative monitoring and supportive measures are also critical to successfully managing patients with this injury.