International Journal of Vascular Surgery and Medicine ISSN: 2455-5452 DOI CC By 033 Citation: Müdüroğlu A, Kayhan TO, Yüksel A (2017) Iliac Vein Injury during Total Hip Replacement: A Rare Iatrogenic Complication and its Successful Surgical Treatment. Int J Vasc Surg Med 3(2): 033-035. DOI: http://doi.org/10.17352/2455-5452.000025 Medical Group Abstract Vascular injury during total hip replacement is a rare condition with the incidence varying between 0.1% and 0.3%. However when develops, it has a potential of serious complications such as extremity loss and even death. Prompt identification and appropriate surgical management of this condition are crucial and may decrease the rate of morbidity and mortality. In this report, we presented a case of iatrogenic iliac vein injury during total hip replacement and its successful surgical management. Case Report Iliac Vein Injury during Total Hip Replacement: A Rare Iatrogenic Complication and its Successful Surgical Treatment Ayhan Müdüroğlu 1 , Taha Oğuz Kayhan 2 and Ahmet Yüksel 3 * 1 Department of Cardiovascular Surgery, Bursa Anatolia Hospital, Bursa, Turkey 2 Department of Emergency, Beylikduzu State Hospital, Istanbul, Turkey 3 Department of Cardiovascular Surgery, Bursa State Hospital, Bursa, Turkey Dates: Received: 16 March, 2017; Accepted: 0 3 April, 2017; Published: 04 April, 2017 *Corresponding author: Ahmet Yüksel, Department of Cardiovascular Surgery, Bursa State Hospital, Tophane Street, 16041, Bursa, Turkey, Tel: + 90 505 8460753; Fax: + 90 224 2132993; E-mail: Keywords: Iliac vein injury; Total hip replacement; Surgical management https://www.peertechz.com Introduction Vascular injury during total hip replacement (THR) is an uncommon phenomenon, but when occurs it may threaten both the extremity and the life of the patient. The most common affected vessels from a vascular injury during THR are external iliac artery and vein, and common femoral artery and vein [1,2]. The early complications of a major vascular injury are mainly bleeding and ischemia, while the late complications are arteriovenous fistula and pseudoaneurysm formation [1,3]. If a bleeding occurs as an early complication, the main indicator of mortality depends on whether the patient is in shock or not [4]. Here, it was reported a case of iatrogenic iliac vein injury during THP, which was successfully treated with appropriate surgical approach. We decided to present this subject as it is seen very rarely. Case Presentation An 18 year-old female patient has undergone THR and shortening procedures in Orthopedic Department due to congenital hip dislocation (CHD). She was consulted to our Cardiovascular Surgery Department because of the existence of hemodynamic instability in the early postoperative period. When the patient examined immediately, it was decided to perform an urgent operation, since there was a strong suspicion of the existence of a massive retroperitoneal hemorrhage. After a right para median incision, the retroperitoneal space was accessed via Tran’s peritoneal approach (Figure 1). Prompt blood transfusion was employed simultaneously. Massive and diffuse hemorrhage precluded the identification of the source of the bleeding. Following employing the packing, the operation was ended. Afterwards, a significant amount of fluid and blood product replacement was administered with both crystalloid and colloid solutions and a total of 18 units of erythrocyte suspension and 18 units of fresh frozen plasma transfusions during early postoperative period. Fluid and electrolyte balances were closely monitored at that time. She was explored surgically with the stable situation hemodynamically at postoperative third day. It was observed that there was no active bleeding in surgical site and the proximal portion of the external iliac vein was injured by the screw-tip drilled to the pelvic bone to fix the metal back of the cup (Figure 2). The screw-tip was cut, and a 5 cm of saphenous vein was harvested from the contralateral leg. In order to prevent embolization, iliocaval junction was externally compressed digitally and thrombi in the proximal venous system with the assistance of a fogarty catheter and Figure 1: Tran’s peritoneal approach to access iliac vein via right para median incision.