[Injuries to femoral vessels in fractures of the hip].

Injury to femoral vessels in trochanteric fractures is a rare but a severe complication. Most often it involves the profunda femoris artery, less often the (superficial) femoral artery. This injury may be caused by different mechanisms; most frequently by pressure of a sharp bone fragment (the lesser trochanter), the tip of protruding cortical screws (extramedullary implant) or the distal locking screw (Gamma nail). Less often it is caused by the drill bit or incorrectly placed elevators. Pressure of a sharp bone fragment or contact with protruding tips of screws results in a gradual erosion of vessels and consequently in development of false aneurysm. Sometimes this defect may become evident as late as several weeks or years after operation. Typical of acute bleeding is tachycardia, hypotension, rapid hematocrite decrease, rapid swelling of the thigh with palpable pulsation and pain. It may be associated also with an audible bruit. In the gradually developed false pseudoanerysm, there dominates a slowly growing swelling and increasing pain. Diagnosis and localization of vascular lesion may be performed using duplex ultrasonography, CT, CT contrast angiography, conventional angiography and MRI. Differential diagnosis should be used to eliminate deep venous thrombosis and sarcoma of soft tissues with bleeding into tumour. Treatment of injury to the profunda femoris artery depends on the condition of the (superficialis) femoral artery. If this artery is not blocked, it is possible to perform embolization or ligation of the profunda femoris artery. Where the superficial femoral artery is obstructed, for instance due to arteriosclerosis, the (superficialis) femoral artery or the profunda femoris artery must be reconstructed. Injury to the (superficial) femoral artery is best treated by its reconstruction.