Endovascular balloon assistance during hip disarticulation

L imb disarticulation has been widely performed since the 18th century, especially in war surgery when reconstructive interventions have not been possible. Actually, limb disarticulation is infrequently done in orthopaedic and vascular surgery, and it is associated with a high mortality rate because of frequent comorbidities. Hip disarticulation usually is reserved for patients with neoplasms or gangrene from severe artherosclerosis. During hip disarticulation, hemodynamic stability can be altered by hemorrhagic events in the femoral artery. The authors propose an endovascular technique for proximal control of the femoral artery to reduce blood loss during hip disarticulation. The procedure was done in a 78-year-old man who had a history of prostate resection for cancer and was under oncological treatment at our institution for 10 years. He developed bone and muscle metastases in the left femur with femoral neck involvement. Because of the slow progression of the disease and the absence of other metastatic lesions, life expectancy was considered to be good, and it was decided to proceed with left hip disarticulation. Because of the proximal location of the tumor, near the femoral neck, the use of a compressive tourniquet was considered impossible, and the vascular surgeon recommended controlling an eventual hemorrhagic event by placing an angioplasty balloon catheter into the left external iliac artery. Color-duplex scanning was performed preoperatively, which showed patency of the iliac and femoral vessels with severe calcifications. Plain abdominal radiographs confirmed diffuse calcification in the arterial axis.