Endovascular treatment of a post-traumatic tibial pseudoaneurysm and arteriovenous fistula: Case report and review of the literature

Catheter-based therapy for traumatic pseudoaneurysm of the anterior tibial artery

Tibial artery pseudoaneurysms often result from penetrating or blunt trauma to the lower extremities, or after orthopedic and endovascular interventions. Clinically, these lesions manifest as an expanding pulsatile mass of the affected area accompanied with pain and erythema. Despite the rare occurrence, traumatic tibial pseudoaneurysms can be associated with significant morbidity including local discomfort, rupture, and lower limb ischemia. Duplex ultrasound is considered the gold standard for diagnosis. Treatment options include surgical repair, ultrasound-guided compression or thrombin injection, and endovascular repair. In this report, we describe a 42-year-old male who presented to our center with pulsatile swelling over the mid-lateral aspect of the left leg. The diagnosis of a large anterior tibial artery pseudoaneurysm was made on clinical basis and was confirmed with computed tomography angiography. The lesion was treated endovascularly with a covered stent graft. In conclusion, this case highlights the role of endovascular therapy as a surgery-sparing and minimally invasive approach in managing traumatic peripheral arterial pseudoaneurysms with excellent clinical outcomes.

Large anterior tibial artery pseudoaneurysm as a rare complication to vascular surgery

A pseudoaneurysm is a rare complication to vascular reconstruction and may be limb threatening if not treated. A patient previously treated for an aneurysm of the left popliteal artery presented to our outpatient clinic with swelling and reduced active movement. Computed Tomography Angiography revealed an 8.1 cm large pseudoaneurysm of the anterior tibial artery (ATA). The pseudoaneurysm was successfully treated with an interposition vascular graft to the patent ATA. Open surgical repair was the only option with resection of the pseudoaneurysm and insertion of an interposition vascular graft with and end-to-side anastomosis. The giant ATA pseudoaneurysm was successfully treated with insertion of a new end-to-side graft anastomosis with interposition to the old patent vascular graft.

Post-traumatic pseudoaneurysm of the medial plantar artery with arteriovenous fistula treated by coil embolization of the main feeding artery and percutaneous thrombin injection

Endovascular treatment for post-traumatic pseudoaneurysm (PsA) has been deemed effective and minimally invasive. However, embolization of all feeding and outflow vessels is difficult if multiple fine arteriovenous fistulas (AVFs) are present. In the present case, PsA of the medial plantar artery with AVF was diagnosed 1 month after injury by a rusty nail. Treatment using a combination of embolization of only the main feeding artery and percutaneous thrombin injection into PsA was successful. This approach can completely resolve PsA in narrow vessels, such as in the foot, particularly when AVF is present with numerous connected vessels.

Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review

Background

Traumatic arteriovenous fistula (TAVF) is an uncommon vascular entity that arises in various locations, often from penetrating injuries, with a wide spectrum of signs and symptoms. This case report highlights the importance of suspecting multiple TAVFs after a single gunshot wound, especially if it involves pellets. It also sheds light on adapting treatment, whether endovascular or open repair, to the location and characteristics of each fistula.

Case presentation

A 35-year-old male, with history of shotgun wound 5 months earlier, presented to our clinic with right lower extremity (RLE) edema and pain. Arterial duplex scan and subsequent angiogram showed two TAVFs at the popliteal and posterior tibial (PT) arteries, both of which could not be exactly localized with a computed tomography angiography (CTA) due to artifacts. The fistula connecting the posterior tibial artery (PTA) and vein was repaired endovascularly using a covered-stent, while the fistula between the popliteal artery and vein was repaired surgically. Postoperative follow-up at 3 months showed no arteriovenous fistula (AVF), patent vessels and distal stent stenosis at the PTA.

Conclusions

Patients who sustain gunshot injuries with shrapnel or pellets and develop TAVF consequentially need to be followed up with the possibility of multiple AVFs in mind. Arterial duplex scan is highly sensitive to detect those AVFs, yet angiography remains gold standard, particularly with extensive metal artefacts. Endovascular repair, when feasible, should be considered first, unless the patient is unstable or has anatomical constraints that increase the risk of complications. Lastly, surgeons should be weary of deep venous thrombosis (DVT), the Branham effect and arterial aneurysmal dilation postoperatively.

Aneurysmectomy and Revascularization of Anterior Tibial Artery Aneurysm: Case Report

An 86-year-old man presented with a pulsatile mass in the anterior compartment of the right lower leg. He had become aware of it two months earlier. Computed tomography angiography revealed a fusiform 3.2×5 cm aneurysm of the anterior tibial artery. Mural thrombosis in the aneurysm was absent. Peripheral pulse was normal. We performed aneurysmectomy and revascularization using a saphenous vein graft. Histological findings revealed that the mass was a true aneurysm. The clinical course was good, and the graft has remained patent for six months.

Digital Arteriovenous Fistula Formation Associated with Bone Fracture Induced Blunt Trauma

An arteriovenous fistula formation caused by a blunt trauma is a quite rare complication, especially in the hand. We report an extremely rare case of a traumatic arteriovenous formation in a finger that developed 5 years after the patient received a blunt trauma in conjunction with a phalangeal bone fracture. Successful management was achieved by direct surgical resection of the arteriovenous fistula without any complication.

Pseudoaneurysm of the Second Dorsal Metatarsal Artery: Case Report and Literature Review

Pseudoaneurysms are a rare complication of foot and ankle surgeries that can potentially lead to serious sequelae, especially when there is delay in the diagnosis. Due to the rarity of this occurrence, guidelines for management are limited for orthopedic surgeons. Once diagnosed, the surgeon has to decide quickly on many options for how to best manage the patient. In this case report, we present the occurrence of a dorsal second metatarsal artery pseudoaneurysm that occurred after removal of hardware. We also discuss the most current literature on the subject to help guide other surgeons in the diagnosis and management of this condition.

Endovascular Treatment of an Anterior Tibial Artery Pseudoaneurysm Secondary to Penetrating Trauma in a Young Patient: Case Report and Literature Review

We report a case of an 18-year-old woman who developed a delayed pseudoaneurysm of the right anterior tibial artery (ATA), 14 days after a knife accidental trauma. The patient was admitted to our emergency department for acute onset of pain in the right limb after a domestic trauma. At a physical examination, the limb was tense and tender, with a pulsatile mass in the anterior compartment. Femoral, popliteal, and distal pulses were palpable on both limbs. Duplex ultrasound scan (DUS) and computed tomography angiography showed the presence of an ATA pseudoaneurysm. An urgent endovascular treatment was performed under local anesthesia via percutaneous access. Pseudoaneurysm was excluded implanting 2 coronary covered balloon-expandable stents (BeGraft; Bentley Innomed GmbH, Hechingen, Germany). Postoperative course was uneventful and the patient was discharged on the second postoperative day under dual antiplatelet therapy. One- and 13-month scheduled follow-up visits and DUS revealed the presence of a normal pedal pulse, complete pseudoaneurysm exclusion, and patency of the stent grafts and the entire ATA with triphasic waveforms. In conclusion, endovascular treatment of an ATA pseudoaneurysm seems to be a feasible option. Further experience with this technique is needed to validate its safety and long-term patency, especially in young and healthy subjects.

Endovascular Therapy of Vascular Trauma—Current Options and Review of the Literature

Objective:

To review the current use of endovascular techniques in trauma.

Summary Background Data:

Multiple studies have demonstrated that, despite current guidelines, endovascular therapies are used in instances of arterial trauma.

Methods:

The existing literature concerning arterial trauma was reviewed. Studies reviewed included case reports, single-center case series, large database studies, official industry publications and instructions for use, and society guidelines.

Results:

Endovascular therapies are used in arterial trauma in all systems. The use of thoracic endografts in blunt thoracic aortic trauma is accepted and endorsed by society guidelines. The use of endovascular therapies in other anatomic locations is largely limited to single-center studies. Advantages potentially include less morbidity due to smaller incisions as well as shorter operating room times. Many report using endovascular therapies even with hard signs of injury. Long-term results are limited by a lack of long-term follow-up but, in general, suggest that these techniques produce acceptable outcomes. The adoption of these techniques may be limited by resource and surgeon availability.

Conclusions:

The use of endovascular therapies in trauma has gained acceptance despite not yet having a place in official guidelines.

Posterior Tibial Neuropathy Secondary to Pseudoaneurysm of the Proximal Segment of the Anterior Tibial Artery with Delayed Onset

Anterior tibial artery is a nonvital artery which is one of the three arteries of the leg. This artery has a short proximal l segment in the popliteal region and a long segment in the anterior compartment of the leg designated as distal segment. With consideration of the deep location of the proximal segment in the popliteal fossa, it is less susceptible to trauma and subsequent formation of an aneurysm. On the contrary, the superficial long distal segment is more susceptible to trauma with high chance of pseudoaneurysm formation at the site of unrecognized injury. In this article, a 38-year-old military man being manifested about a decade after a trivial missile fragment injury with progressive posterior tibial neuropathy is presented. A giant pseudoaneurysm arising from the proximal segment of the anterior tibial artery was confirmed with angiography and the exact size of this pathology was documented with contrasted computed tomographic scan. The aneurysmal sac removal was accomplished after ligation of the corresponding artery proximal and distal to the sac followed by tibial nerve neurolysis which result in full recovery. In careful review we found that neither pseudoaneurysm arising from the proximal tibial artery nor posterior tibial neuropathy due to the compressive effect of the aneurysmal sac of this segment has been reported previously. Our primary purpose for reporting this case is not to describe the rarity of pseudoaneurysm formation at proximal segment of this artery but rather to describe delayed-onset posterior tibial vascular compressive neuropathy due to such an aneurysm. Eventually due to the potential sequel of a pseudoaneurysm, it is important for the surgeons to have high index of suspicion to prevent a missed or delayed diagnosis.

Retrograde embolization of anterior tibial artery for an iatrogenic arterio-venous fistula causing left lower extremity claudication

Lower extremity angiogram is generally a safe and effective procedure with a low rate of vascular complications. We report here a unique case of a 33-year-old female with anterior tibial artery (ATA) to anterior tibial vein fistula formation after lower extremity endovascular intervention. This was initially treated with open repair of the fistula and ligation of ATA. However, patient continued to complain of claudication like symptoms. Patient subsequently had an endovascular embolization of ATA in a retrograde fashion. Recovery was unremarkable; patient was discharged home same day. Three months postoperatively patient denies leg pain, a follow-up arterial duplex failed to show presence of arterio-venous fistula. This case illustrates the effectiveness of an endovascular approach as a minimally invasive treatment for this uncommon complication that occurs after lower extremity endovascular intervention.

Ruptured Pseudoaneurysm of the Dorsalis Pedis Artery Following Ankle Arthroscopy: A Case Report

CASE

We describe the case of a pseudoaneurysm of the dorsalis pedis artery that developed following a repeat ankle arthroscopy for persistent osseous impingement. The patient underwent attempted fluid aspiration for a presumed effusion, and ultimately experienced rupture of the pseudoaneurysm with substantial blood loss, which required emergency vascular repair.

CONCLUSION

Anterior tibial artery and dorsalis pedis artery pseudoaneurysms are relatively rare, but they are well-documented complications of ankle arthroscopy; however, their clinical importance is poorly understood. To our knowledge, this is the first reported case of a ruptured pseudoaneurysm of the dorsalis pedis artery following ankle surgery, and it highlights the need for timely diagnosis.

A case report of an anterior tibial artery pseudo-aneurysm open surgical management: A rare complication post total knee arthroplasty

INTRODUCTION

Complications involving injury to neurological and vascular structures are infrequently reported after total knee arthroplasty (TKA). They are associated with significant morbidity and can be limb threatening.

PRESENTATION OF CASE

We present a patient with an anterior tibial artery (ATA) aneurysm post total knee arthroplasty. A 69-year-old female was referred for a swelling over her left antero-lateral aspect of her leg 4 years post TKA. Radiological investigations showed an ATA pseudo aneurysm. The aneurysm was repaired by open ligation.

DISCUSSION

ATA pseudo aneurysm is a rare condition post arthroplasty. Patients can complain about calf pain, digits discoloration, paresthesia and the presence of a pulsating or enlarging mass. Symptomatic aneurysms require surgical intervention.

CONCLUSION

ATA pseudo aneurysms are uncommon. They are usually identified shortly after the initial insult. A delayed manifestation of a post knee arthroplasty complication as illustrated in our case is likely the first reported case of its kind. Clinicians should maintain a high index of suspicion should there be persistent localised swelling post TKA. However, due to the rarity of this condition, a variety of interventions have been reported in the English medical literature with probably no compelling evidence that favors one modality over the others.

Chronic leg swelling and palpitation as a late complication of post-traumatic arteriovenous fistula: A case report

Introduction

Chronic post-traumatic arteriovenous fistula (AVF) is a late complication of vascular injury and can be presented with symptoms of congestive heart failure, venous hypertension and distal ischaemia. We present an unusual case of chronic leg swelling in adult caused by post-traumatic AVF.

Case presentation

A 52 year old white-male patient complained of palpitation, pain and swollen right leg. Arterial pulses distally from the groin were present. His medical history revealed him to have sustained gunshot injury of the left thigh 5 years before. Angiography showed a large AVF between superficial femoral artery and femoral vein. The patient underwent surgical repair of AVF with ligation of AVF between superficial femoral artery under spinal anaesthesia. Completion angiography confirmed AVF exclusion. Leg swelling healed within a month.

Conclusion

Post-traumatic fistula should be obliterated as soon as possible. Untreated fistula results in complications including renin-mediated hypertension and high-output heart failure, venous and/or arterial insufficiency.

Successful Stenting of Iatrogenic Anterior Tibial Artery Pseudoaneurysm

Introduction

The use of covered tibial stents extends beyond the treatment of atherosclerotic disease. Tibial artery pseudoaneurysms have traditionally been managed with open surgery; however, the endovascular option is an emerging treatment.

Report

This report describes endovascular management of an iatrogenic anterior tibial artery pseudoaneurysm using a covered stent.

Conclusion

This case highlights the use of a covered stent for pseudoaneurysm exclusion, vascular control, and to minimize dissection in a patient with multiple previous surgeries.

[Coil embolization therapy in post-traumatic pseudoaneurysms and arteriovenous fistula of knee and leg arteries]

Pseudoaneurysms remain a rare complication of knee and leg trauma. They may go unnoticed and manifest late after the initial trauma; they are often associated with arteriovenous fistula. No standard treatment is recognized. We report a case of post-traumatic pseudoaneurysm of the inferior articular artery of the knee, treated by coil embolization and a case of post-traumatic pseudoaneurysm of the anterior tibial artery associated with an arteriovenous fistula, treated with coil embolization and decompression surgery. Follow-up in both patients was satisfactory.

[Post-traumatic femoral arteriovenous fistula, endovascular treatment]

BACKGROUND

Arteriovenous fistulas secondary to gunshot wounds have been increasing due to military activities, with endovascular treatment showing better results in haemodynamically stable patients.

CLINICAL CASE

A 16 year-old male with diagnosis of femoral arteriovenous fistula in the left lower extremity was admitted to general surgery for endovascular management. A procedure with stent was performed without complications, and is currently on anticoagulant and antiplatelet treatment.

CONCLUSION

Arteriovenous fistulas under the inguinal region can be safely treated with endovascular treatment (embolisation or stent) on stable patients. The objective of this therapy is to close the defect between artery and vein. This is the case of a patient with great results due to endovascular treatment, decreasing complications of the surgical treatment.

Nonunion of the tibial facture as a consequence of posterior tibial artery pseudoaneurysm

Pseudoaneurysm of the posterior tibial artery (PTA) is uncommon, and they mainly occur following high-velocity trauma, open fractures and can be iatrogenic in nature. To the best of our knowledge, this is the first reported and successfully treated case of PTA pseudoaneurysm identified as a consequence of tibia fracture nonunion in an otherwise healthy young individual 6 months following the original incident with a novel intraoperative technique.

Traumatic pseudoaneurysm of the posterior tibial artery treated by endovascular coil embolization

Pseudoaneurysms of the posterior tibial artery are rare, but a high index of suspicion should be maintained in evaluating patients who present with a painful swelling after arterial trauma. We report a case of a posterior tibial artery pseudoaneurysm in a young patient sustained from a laceration and associated profuse arterial bleeding. Because of the risk of rupture and the presence of an infection and high venous flow, an embolization of the aneurysm proximally and distally was carried out after verifying that distal collateral circulation ensured foot vascularization. Endovascular treatment of a pseudoaneurysm seems to be a safe therapeutic and noninvasive choice, particularly in young patients in whom the presence of collaterals guarantees distal vascularization and in whom the procedure can be safely performed in the presence of a superficial wound infection.

Anterior tibial artery aneurysm: Case report and literature review

INTRODUCTION

We present a patient with a true anterior tibial artery aneurysm without any causative history.

PRESENTATION OF CASE

A 59 year old male was referred with a swelling on his left lateral ankle which he noticed 2 months ago, with symptoms of soaring pain. Additional radiological research showed a true arterial tibialis anterior aneurysm. True anterior tibial artery aneurysm is a rare condition. The aneurysm was repaired by resection and interposition of a venous bypass.

DISCUSSION

Patients may complain about symptoms like calf pain, distal ischemia, paresthesias due to nerve compression and the presence of a pulsating or increasing mass. Symptomatic aneurysms require surgical intervention, where bypass with a venous saphenous graft have shown good patency and endovascular treatment have shown good short term results. Asymptomatic and small aneurysm can be followed for several years with DUS.

CONCLUSION

Clinical features, radiographic findings, surgical management, and a review of the literature on true anterior tibial aneurysms are discussed.

Leg ulcer as a complication of a posttraumatic tibial arteriovenous fistula treated by endovascular approach with stent-graft placement

Endovascular treatment of posttraumatic arteriovenous fistulae (AVFs) in the lower extremities by means of covered stent-grafts is widely accepted, and many cases have been reported in the iliac-femoral region. However, few reports exist on the treatment of infrapopliteal AVFs, with or without a pseudoaneurysm, using this method. The authors present this case report dealing with a patient who had undergone a tibial and peroneal open fracture in his left limb 34 years ago. He developed a leg ulcer as a consequence of AVF between the tibialis posterior artery and vein, which resulted in venous insufficiency, which was treated by the endovascular approach with the placement of a stent-graft. Total healing was achieved over a period of 3 months. Angio-CT was performed, showing stent-graft patency 6 months after the endovascular procedure.

Delayed presentation of traumatic infrapopliteal arteriovenous fistula and pseudoaneursym in a 10-year-old boy managed by coil embolization

Blunt traumatic arteriovenous fistulae of the extremities are rare in children. We report the case of a 10-year-old boy with a traumatic infrapopliteal arteriovenous fistula and concomitant pseudoaneurysm diagnosed 2 months after he was struck by a car. It was definitively managed with coil embolization. Postprocedure, the vascular anatomy of the patient's right calf was well preserved. He had complete resolution of his symptoms immediately after the intervention and continues to do well 6 months later.

Lower extremity vascular stenting for a post-traumatic pseudoaneurysm in a young trauma patient

Endovascular treatment of post-traumatic pseudoaneurysms has become a viable, less invasive option when compared to open repair. Due to the relative youth of this technology, studies have yet to be concluded on the long-term patency of stent grafts in this population. For this reason, concern exists with endovascular stent placement in the young trauma patient. In this study, we present a case and review the literature on a post-traumatic pseudoaneurysm of the posterior tibial artery in a 19-year-old man treated with an endovascular stent.

Use of stent grafts in lower extremity trauma

BACKGROUND

Permanent endovascular stenting is gradually becoming recognized as a safe and efficacious method for treating a variety of arterial diseases. The literature on its application in trauma care is sparse, although indications for usage continue to evolve.

METHODS

We retrospectively reviewed all penetrating extremity trauma treated with endovascular therapy at our medical center between 2005 and 2008.

RESULTS

We present three patients with three different arterial lesions in the superficial femoral artery (SFA) which were caused by penetrating injury. The arterial lesions include a mid-thigh SFA pseudoaneurysm, an intimal disruption of the distal SFA, and an arteriovenous fistula involving the SFA and superficial femoral vein. All were treated with expanded polytetrafluoroethylene-covered stents and showed excellent short-term results. A percutaneous approach to this problem may reduce blood loss, decrease length of stay, involve fewer iatrogenic nerve injuries, and facilitate shorter recovery time, as compared with open approaches.

CONCLUSIONS

Endovascular-covered stent placement for traumatic arterial extremity injury was used with excellent results and no morbidity in this small series of patients. Endovascular solutions for arterial extremity injuries warrant further investigation for short- and long-term results.

Pseudoaneurysm of the anterior tibial artery after a tibial bone true-cut needle biopsy treated by an arterial resection and anastomosis

We report the case of a 38-year-old man who developed a false aneurysm of the anterior tibial artery after a true-cut needle biopsy of the shinbone. Although arterial damages are a known theoretical risk of such a procedure, to our knowledge, this is the first case to be reported. Repair was achieved by means of an arterial resection and anastomosis.

The role of stent grafts in the management of traumatic tibial artery pseudoaneurysms: case report and review of the literature

Tibial artery pseudoaneurysms can occur in the setting of trauma. Operative exposure and repair of these injuries can be challenging, and surgical management options include direct arterial repair, interposition grafting, or arterial ligation. Other techniques including duplex-guided compression, thrombin injection, and endovascular intervention have been described. We present the case of a 39-year-old man who sustained blunt trauma to his right lower extremity and developed a delayed symptomatic pseudoaneurysm of the posterior tibial artery. He was successfully managed with endovascular stent graft exclusion of the pseudoaneurysm. Endovascular stent-grafting techniques can be successfully applied to the management of traumatic tibial pseudoaneurysms.

False aneurysm at the origin of the anterior tibial artery after opening wedge osteotomy

We report the case of a false aneurysm at the origin of the anterior tibial artery complicating upper tibial osteotomy. The proximally located lesion compressed the posterior tibial nerve, and despite successful decompression, the patient suffers from probably irreversible neurologic after-effects. Even though it is rare, this complication must be considered when faced with leg pain consecutive to upper tibial osteotomy without deep venous thrombosis.

Endovascular repair of post-traumatic, concomitant popliteal artery pseudoaneurysm and arteriovenous fistula

Popliteal artery trauma is a potentially devastating injury to the lower extremity with substantial associated morbidity. Pseudoaneurysm and arteriovenous fistula formation are complications of arterial injury that often present in a delayed fashion. Although these have traditionally been repaired using an open procedure, the growth of minimally invasive techniques has provided new therapeutic options for the treatment of such lesions. The present report discusses the successful treatment of concomitant popliteal pseudoaneurysm and arteriovenous fistula after delayed presentation by placing covered stents endovascularly.

Posterior tibial artery pseudoaneurysm identified subsequent to surgical wound dehiscence

The development of a pseudoaneurysm of the posterior tibial artery is a rare event. In this article, we describe the case of a 63-year-old female with rheumatoid arthritis, who initially presented with a symptomatic subcutaneous nodule localized to the medial aspect of the right ankle. After excision of the subcutaneous nodule, she failed to heal the surgical wound and, eventually, the pseudoaneurysm of the posterior tibial artery was identified. It was not until after the posterior tibial artery was ligated and the pseudoaneurysm excised, that the wound finally healed.

LEVEL OF CLINICAL EVIDENCE

4.

Emergency endovascular management of peripheral artery aneurysms and pseudoaneurysms - a review

Endovascular stenting has been successfully employed in the management of aortic aneurysms; however, its use in managing peripheral arterial conditions remains questionable. We review the utility of endovascular technique in the management of peripheral arterial conditions like aneurysms, pseudoaneurysms and arterio-venous fistulas in the emergency setting. Though long term data about graft patency rates is not yet available, the endovascular approach appears to be a useful minimally invasive technique in situations where open repair is either difficult or not feasible.

Crural artery traumatic injuries: treatment with embolization

The purpose of this paper is to report our experience with the endovascular treatment of crural arterial injuries using transcatheter and direct embolization techniques. A total of eight consecutive patients have been treated during a 7-year period. Six males and two females, mean age 32 years (range, 15-56 years), presented with penetrating trauma to the lower extremities. Mechanisms of injuries were stab wounds in six patients, gun shot wound in one patient, and iatrogenic injury in one patient. Five patients presented with acute trauma, while three patients presented with delayed injuries. Crural arterial injuries encountered included pseudoaneurysms with arteriovenous fistulas (n = 6), pseudoaneurysms with vessel transections (n = 2), and pseudoaneurysm (n = 1). Proximal and distal embolization with coils was used in three cases, proximal embolization with coils in three cases, percutaneous thrombin injection in one case, and liquid n-butyl cyanoacrylate in one case. Complete exclusion of the lesions was accomplished by sacrifice of one crural vessel in seven cases and of two crural vessels in one case. Two cases of delayed injuries required combined coil and liquid embolization techniques for lesion exclusion. A minor complication (groin hematoma) occurred in one patient, no distal ischemia was seen, and no amputations were required. Mean follow-up was 61 days (range, 1-180 days). One pseudoaneurysm treated with thrombin injection recurred and required surgical excision. We conclude that transcatheter embolization alone or in combination with different endovascular techniques is useful in the treatment of traumatic crural vessel injuries.