Acute Surgical Management of Vascular Injuries in Hip and Knee Arthroplasties

Christopher M. Melnic, MD; Marilyn Heng, MD, MPH, FRCSC; Santiago A. Lozano-Calderon, MD, PhD


J Am Acad Orthop Surg. 2020;28(21):874-883. 

In This Article

Treatment of a Vascular Injury at an Ambulatory Surgery Center

When a vascular injury is encountered at an ambulatory surgery center, identification of the bleeding source and communication with the anesthesia team are of utmost importance. In the setting of a total hip arthroplasty, if hemodynamically instability or profuse bleeding is present, we recommend gaining proximal and distal control by dissecting the iliac vessels as described above, packing, and then transferring the patient to a hospital setting if vascular surgery is not available. If the patient is hemodynamically stable, we recommend packing the surgical wound and then reevaluation of the surgical wound. If bleeding continues, we again recommend dissection of the iliac vessels that will allow proximal and distal control before the patient is transferred to a hospital. In the setting of a total knee replacement, we recommend either placing a tourniquet or reinflating the tourniquet that is already in place and transferring the patient to the nearest hospital with a vascular surgeon.