Selective transarterial embolization for vascular complications after hip fracture surgery: An eleven-year experience in a tertiary trauma center.

BACKGROUND

Arterial injury following hip fracture surgery is an uncommon but potentially life-threatening complication. Delayed recognition may result in persistent bleeding, severe anemia, and hemodynamic instability. Selective transarterial embolization (TAE) has emerged as a minimally invasive treatment. The aim of this study was to evaluate the clinical presentation, management, and outcomes of postoperative arterial bleeding treated with TAE after hip fracture surgery.

METHODS

A retrospective study was conducted including 14 consecutive patients (11 women, 3 men) who underwent TAE for postoperative arterial bleeding after hip fracture surgery between 2013 and 2024. The median age was 83.1 years (72.0-88.6 IQR). Demographic characteristics, comorbidities, anticoagulation status, clinical presentation, imaging findings, embolization techniques, transfusion requirements, complications, and follow-up were analyzed.

RESULTS

Among 3520 hip fractures treated during the study period, the incidence of vascular complications requiring embolization was 0.32%. Fracture patterns included pertrochanteric (n = 9), subtrochanteric (n = 3), and intracapsular fractures (n = 2). Persistent bleeding and progressive anemia despite transfusion were the most common indications for angiographic evaluation. Seven patients (50%) were receiving anticoagulation therapy preoperatively. Contrast-enhanced computed-tomography (CT) angiography was performed in 86% of cases and identified active bleeding in most patients. The most frequently injured vessels were branches of the deep femoral artery (n = 9) and superior gluteal artery (n = 5). Embolization was performed using coils, gelatin sponge particles, polyvinyl alcohol, or ethylene-vinyl alcohol copolymer. Technical success was achieved in all cases, although two patients (14%) required repeat embolization. One patient (7%) developed deep infection. Mortality during follow-up was 36%.

CONCLUSION

Early recognition of arterial injury after hip fracture surgery is essential. In our series, selective transarterial embolization was successfully used to control postoperative arterial bleeding with no major procedure-related complications, suggesting it may be a safe and feasible minimally invasive treatment option in selected patients.