Popliteal Venotomy During Posterior Cruciate Ligament Reconstruction in the Setting of a Popliteal Artery Bypass Graft

• Published in: Arthroscopy Vol. 28; no. 2; pp. 294 - 299
• Main Authors: Nemani, Venu M., M.D., Ph.D, Frank, Rachel M., M.D, Reinhardt, Keith R., M.D, Pascual-Garrido, Cecilia, M.D, Yanke, Adam B., M.D, Drakos, Mark, M.D, Warren, Russell F., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2012; Elsevier
• Subjects: Arthroscopy; Arthroscopy - adverse effects; Biological and medical sciences; Endoscopy; Female; Heart Arrest - etiology; Humans; Intraoperative Complications; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Orthopedic surgery; Orthopedics; Popliteal Artery - surgery; Popliteal Vein - injuries; Posterior Cruciate Ligament - injuries; Posterior Cruciate Ligament - surgery; Pulmonary Edema - etiology; Reconstructive Surgical Procedures - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular Surgical Procedures - adverse effects; Young Adult; Arthroscopy; Orthopedic surgery; Posterior cruciate ligament; Treatment; Bypass; Popliteal artery; Graft; Endoscopy
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2011.11.023

Abstract Injury to the vascular structures in the popliteal fossa during arthroscopic cruciate ligament reconstruction can be limb threatening or even life threatening. We present the first report, to our knowledge, of an isolated injury to a popliteal vein during arthroscopic posterior cruciate ligament reconstruction. Unfortunately, the venotomy led to cardiopulmonary arrest and flash pulmonary edema in this patient. Preoperative planning is paramount to assess risk of injury to vascular structures, which may be increased in patients who have had prior procedures on the affected knee. Furthermore, vascular surgery consultation preoperatively after a magnetic resonance angiogram or venogram and avoiding the use of epinephrine in the arthroscopy fluid should be considered when performing these higher-risk procedures.