‘Remain calm, diligent’ in the face of vascular injuries during TKA
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Key takeaways:
- Surgeons need to remain calm but diligent with the occurrence of a vascular injury during total knee arthroplasty.
- If surgery is performed in an ASC, there should be a plan in place in case of vascular injury.
DALLAS — While rare, vascular injuries during total knee arthroplasty do occur, with the most common being injury to the popliteal artery, according to a presenter at the American Association of Hip and Knee Surgeons Annual Meeting.
In his presentation, Christopher Melnic, MD, said there are two key pillars for successful management of vascular injuries to the popliteal artery in the OR.
“The first is to remain calm, but diligent,” Melnic, director of the Adult Reconstructive Surgery Fellowship Program at Massachusetts General Hospital and assistant professor of orthopedic surgery at Harvard Medical School, said. “Also, have clear communication, not only with anesthesia but the nursing staff that is in the operating room.”
If a tourniquet is not placed, Melnic said to apply firm pressure, consult a vascular surgeon, if available, and, once the patient is stable, assess the extent of the injury. He said consider placing a tourniquet if one is not already in use and remember the application times.
“It is recommended to place your time when you placed your tourniquet on a whiteboard or something along those lines, so you understand how long the patient’s limb has been ischemic,” Melnic said.
He said surgeons want to have proximal control if the injury is arterial and distal control if the injury is venous.
If performing surgery in an ASC, Melnic said to confirm the patient is stable and apply a tourniquet. Prior to transfer to a hospital setting, the surgeon should call the vascular surgeon to ask if there is anything that should be done, according to Melnic.
“Specifically to surgical centers ... it is important to remember that vascular surgeons are often not present and often can be 45 minutes to 1 hour away,” Melnic said. “It is key and vital to have a plan set up at your surgery center what to do if the rare occasion this does happen. How are you going to manage it and how is the patient going to do OK and be able to transfer to an outside hospital, if necessary.”
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Melnic C. Symposium I: How to manage intraoperative complications during primary TKA. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 7-10, 2024; Dallas.
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