Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 177-180

Kendiliðinden “yer deðiþtiren” kalça protezine baðlý geliþen femoral arter oklüzyonu: Olgu sunumu

Deniz Necdet Tihan¹, Halil Alýþ², Murat Aksoy¹, Recep Güloðlu¹, Mehmet Kurtoðlu¹, Fatih Dikici^3
1Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul, Türkiye
²Bakýrköy Sadi Konuk Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul, Türkiye
³Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Ortopedi Ve Travmatoloji Anabilim Dalý, Ýstanbul, Türkiye

Yetmiþ yedi yaþýndaki erkek hasta hastaneye sol alt ekstremitede giderek kötüleþen akut iskemi bulgularýyla baþvurdu. Hastanýn hikayesinden, ortopedi kliniðinde koksartroz tanýsýyla total eklem protezi uygulandýðý ve altý ay sonra protezinin revize edildiði öðrenildi. Fiziksel incelemede sol alt ekstremite distal nabýzlarýnýn femoral arter düzeyinden itibaren alýnamadýðý saptandý. Sol kalça hareketleri aðrýlý ve dýþ rotasyon duruþu sýnýrlý idi. Doppler ultrasonografide sol ortak femoral arterde akut týkanýklýk olduðu saptandý ve hastaya saðdan sola femoro-femoral politetrafloroetilen greft ile baypas uygulandý. Baþarýlý cerrahi ve sorunsuz ameliyat sonrasý palpabl femoral ve popliteal atýmlý hastaya düþük molekül aðýrlýklý heparin verildi; hasta ortopedi kliniðine tedavisinin devamý için sevk edildi. Literatürde total kalça protezinin yer deðiþtirmesine baðlý vasküler oklüzyonlar ile ilgili bildirilmiþ olgu sunumlarýnýn nadir olmasý nedeniyle bu ilginç olguyu ve uyguladýðýmýz cerrahi giriþimimizin sonuçlarýný paylaþmak istedik.

Anahtar Kelimeler: Femoro-femoral baypas, kalça protezi dislokasyonu; alt ekstremite akut iskemisi; total eklem protezi; vasküler oklüzyon.

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Femoral artery occlusion secondary to a spontaneously “migrated” hip prosthesis: case report

Deniz Necdet Tihan¹, Halil Alýþ², Murat Aksoy¹, Recep Güloðlu¹, Mehmet Kurtoðlu¹, Fatih Dikici^3
1Department Of General Surgery, Istanbul University, Istanbul Faculty Of Medicine, Istanbul, Turkey
²Department Of General Surgery, Bakirkoy Sadi Konuk Training And Research Hospital, Istanbul, Turkey
³Department Of Orthopedics And Traumatology, Istanbul University, Istanbul Faculty Of Medicine, Istanbul, Turkey

A 77-year-old male patient was admitted to the hospital with a worsening acute ischemia of the left lower extremity. The patient, who had a coxarthrosis and was being followed by the orthopedic clinic, had undergone a total hip prosthesis, with a revision performed at the sixth month of its placement. The physical examination revealed the absence of the femoral, popliteal and distal pulses of the left lower extremity. The left hip movements were painful and limited in external rotation posture. Doppler ultrasonography showed an acute occlusion of the left common femoral artery due to the dislocated hip prosthesis, and right-to-left femorofemoral expanded polytetrafluoroethylene graft bypass was carried out. After successful surgery and an uneventful postoperative period with palpable femoral and popliteal pulses, the patient was put on low molecular weight heparin and referred to orthopedics once the ischemia had subsided with the intervention. Case reports regarding occlusions due to migration of total hip prosthesis are rare in the literature. The emphasis of this case report is to describe one such case.

Keywords: Femorofemoral bypass, hip prosthesis dislocation; lower extremity acute ischemia; total hip prosthesis; vascular occlusion.

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ATIF KOPYALA