• Ji Young Min, Kyungmoon Roh, Seunghee Cho, Sanghyun Hong, and Mee Young Chung.
• Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul.
• Medicine (Baltimore). 2021 Jan 29; 100 (4): e23614e23614.

IntroductionVenous air embolism (VAE) from vascular injuries, is of rare occurrence but can result in catastrophic complications during total hip arthroplasty (THA). Early recognition and prompt management of vascular injury are required to avoid severe complications. Especially, bleeding is generally associated with profound hypotension in venous injury. We report an unusual complication of venous air embolism induced by femoral vein rupture during THA.Patient ConcernsA 54-year-old male patient with a history of old left acetabular fracture was scheduled for THA. We experienced massive bleeding and VAE induced by femoral vein rupture during total hip arthroplasty. The BP suddenly dropped from 100/70 mm Hg to 80/50 mm Hg with massive bleeding. ETCO2 and SaO2 decreased profoundly.DiagnosisThe VAE was diagnosed by the change in end- tidal CO2 (ETCO2) and change of vital signs, so we performed ABGA and inserted TEE for confirmination.InterventionsFor treatment, patient was managed by oxygen therapy, inotropics, vasopressor, transfusion and surgical repair.OutcomesUpon consulting with a cardiologist, the patient was extubated the next day and was transferred to the general ward and recovered without serious complications. He stayed for 17 days until finally discharged without complications.ConclusionPreoperative vascular imaging may be recommended in the revisional case of THA or in patients with the history of hip trauma. The monitoring of ETCO2 and TEE might be helpful to recognize VAE earlier and therefore to avoid catastrophic complications through adequate treatment.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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