Femoral Artery Dissection after Adductor Canal Block
Bibliographic record
Abstract
After an uneventful total knee arthroplasty under spinal anesthesia and ultrasound-guided continuous adductor canal block, the absence of distal pulses was noted in the operative leg. An arterial duplex scan (top image, panel A) demonstrated a femoral artery dissection flap (thin arrow) with a false lumen (thick arrow). Color Doppler demonstrated an absence of arterial flow distal to the dissection (top image, panel B; asterisk). During emergent thrombectomy and arterial repair, a puncture site of the Tuohy needle was noted on the femoral artery (thin arrow; bottom image, panel A), with perivascular hematoma (thick arrow; bottom image, panel A) and an intravascular thrombus (bottom image, panel B). The patient subsequently regained limb perfusion.Inadvertent vascular puncture is a known complication of peripheral nerve blockade. The use of ultrasound guidance for peripheral nerve blockade improves safety and reduces the risk of vascular puncture.1 The rate of vascular puncture after femoral nerve blockade is 1.1%;2 ultrasound-guided adductor canal block is considered safe, and vascular complications, including hematoma and pseudoaneurysm formation, appear to be rare.3This image shows that vascular puncture during peripheral nerve blocks may be associated with important complications, and underscores the importance of routine surveillance for adverse vascular events.Vascular puncture should prompt frequent assessment of limb perfusion, to avoid missing time-sensitive, limb-threatening complications, and should be considered in the differential diagnosis of limb ischemia after peripheral blocks, prompting emergent vascular consultation.The authors declare no competing interests.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".