Ruptured popliteal artery pseudoaneurysm complicating a femoral osteochondroma in a young patient

Popliteal Artery Occlusion Due to Femur Exostosis in a Patient With Rheumatoid Arthritis: A Rare Cause of Chronic Limb-Threatening Ischemia

Bony exostoses, or osteochondromas, are benign bone tumors that usually develop at growth plates during the growth period. Large exostosis can compress nearby vascular structures, causing occlusion, perforation, or pseudoaneurysm. We report a case of a middle-aged woman with rheumatoid arthritis (RA) and atherosclerotic risk factors who had an unusual presentation of chronic limb-threatening ischemia (CLTI) of the left leg combined with a flare-up of RA. She was found to have an occluded left popliteal artery due to a large femur exostosis. An uncomplicated left femoral-to-popliteal bypass was performed using a reversed great saphenous vein without excision of exostosis. Her ischemic symptoms have been resolved during a 30-month follow-up period. A high index of suspicion is required in such a case to reach the correct diagnosis and prevent catastrophic limb loss.

Popliteal artery pseudoaneurysms in patients affected by osteochondroma

Although exostosis or osteochondroma is a common bone tumor, associated vascular complications are rare. Clinical and radiological diagnoses are sometimes challenging, and there is no codification for surgical management. We report two cases of popliteal arterial pseudoaneurysms due to osteochondroma of the distal femur. A review of the current literature about case series and case reports of patients affected by arterial pseudoaneurysm complicating osteochondroma was also performed.

Idiopathic pseudoaneurysm of the popliteal artery with endovascular treatment: A case report

Popliteal pseudoaneurysms are a rare vascular pathology, usually caused by trauma or iatrogenic interventions. Idiopathic cases are exceptionally uncommon. This case report aims to describe the diagnosis and successful endovascular treatment of an idiopathic pseudoaneurysm of the popliteal artery in a 90-year-old bedridden female patient presented with acute pain and swelling in the left knee at the emergency department. The patient underwent successful endovascular treatment with a covered stent and thrombin injection, leading to complete exclusion of the pseudoaneurysm. Popliteal pseudoaneurysms are a rare pathology, and idiopathic cases are even more uncommon. Endovascular therapy for popliteal pseudoaneurysms is associated with lower morbidity and mortality rates compared to open surgical repair. This case report highlights the importance of interdisciplinary collaboration between vascular surgeons and interventional radiologists in the management of rare vascular pathologies.

Superficial femoral artery pseudoaneurysm caused by a solitary femoral shaft osteochondroma in a young adult

We discuss the presentation, diagnosis, and surgical management of a young man presenting with a symptomatic superficial femoral artery pseudoaneurysm caused by a solitary femoral shaft osteochondroma. We review the existing literature regarding the incidence and management of this problem.

Popliteal Artery Pseudoaneurysm Caused by Osteochondroma

A 16-year-old boy developed pulsating pain and dysesthesia in his right knee. Computed tomography showed a large aneurysm in the right upper popliteal artery and a spiked bone tumor arising from the right distal femoral shaft. Pseudoaneurysm due to osteochondroma was suspected, and the patient underwent emergency surgery. A 2-mm pinhole was detected in the arterial wall behind the tumor. After resection of the tumor, the damaged arterial wall was removed, and the defect was repaired using a saphenous vein patch. We suggest that patch repair is preferable to direct closure or end-to-end anastomosis to prevent recurrent pseudoaneurysm at a later time, even if the defect is small.

Imaging of benign complications of exostoses of the shoulder, pelvic girdles and appendicular skeleton

Exostoses are the most common benign bone tumors, accounting for 10 to 15% of all bone tumors. They develop at the bone surface by enchondral ossification and stop growing when skeletal maturity has been reached. At first, exostoses are covered by a smooth cartilage cap that progressively ossifies with skeleton maturity. Then they may regress, partly or even completely. Osteochondromas may be solitary or multiple, with the latter associated with hereditary multiple exostoses (HME). Exostoses develop during childhood and become symptomatic during the third decade of life in the case of solitary exostoses, or earlier, in case of HME. They stop growing after puberty, when the epiphyseal plates close. Most exostoses remain asymptomatic. Local complications, usually benign, may occur, such as fractures or mechanical impingements upon nearby structures. In rare cases, sarcomatous degeneration occurs. Most of these complications have been described in case reports. This article describes the imaging features of benign complications of exostoses of the shoulder, pelvic girdles and appendicular.

[Management of popliteal artery pseudoaneurysms as a result of limb trauma and orthopedic surgery or associated with osteochondromas]

Most published articles regarding popliteal artery pseudoaneurysms (PAPs) are case reports and in English language literature. In this context, no study with robust data was previously published. The exact epidemiology of these APs is not well-known and their management is not yet codified. We wanted to summarize the current knowledge on diagnostic and therapeutic features of PAPs as a result of limb trauma and orthopedic surgery or associated with osteochondromas. An electronic research on MEDLINE and EMBASE between 1953 and March 2015 was performed; using the key words "popliteal pseudoaneurysm". The referenced articles were selectively read and this systematic review included 116 articles. Patient demographics; clinical presentations; diagnostic and therapeutic features were reviewed. In sum, 122 cases were analyzed. Overall young adult (average age=30.48±21.25 years old) represented the majority of the affected population with a masculine preponderance (79%). The main etiologies included femoral exostosis (63%), followed by the orthopedic surgery (25%) and direct trauma into the knee (10%). Painful swelling (44%) and/or pulsatile mass (39%) represented the most commonly presenting symptoms. The commonest radiological investigations used included arteriography (49%) and CTA (27%). The treatment was open surgical repair (85%) or endovascular stenting graft (14%). Post-therapeutic courses were often uneventful (98%). The morbidity rate was low at about 2%. The treatment of direct post-traumatic PAPs was usually open surgical repair (83%) with saphenous vein grafting. Endovascular stenting may be an ideal option for managing PAPs following orthopedic surgery (88%). Open surgery for vascular repair and maximum exostectomy must be undertaken concomitantly in the setting of APs associated with osteochondromas.

Management of extremity arterial pseudoaneurysms associated with osteochondromas

Arterial pseudoaneurysms associated with osteochondromas are rare and most publications on this topic are case reports. The management of this double entity is not standardized. We wanted to update it. Literature searches on MEDLINE and EMBASE were performed using the keywords "artery pseudoaneurysm" and "osteochondroma". Patient demographics, clinical presentations, diagnostic and therapeutic modalities were reviewed. In sum, 101 cases were analyzed. Overall, young adults represented the majority of the affected population with a masculine preponderancy (86%). Painful swelling (51%) was the most commonly physical finding. Distal femur was the most common site of the osteochondroma (86%). Multiple hereditary exostosis was seldom reported (36%). Diagnostic confirmation was dominated by arteriography (55%). Popliteal artery (77%) was the most commonly injured vessel. The treatment was open surgery with vascular repair and optimal exostectomy. Arterial repair was performed with saphenous vein grafting (40%) or lateral suture (39%). Postoperative courses were often uneventful (97%). Arterial pseudoaneurysms resulted from osteochondromas were dominated by those involving the popliteal artery. The use of arteriography to confirm the diagnosis may be limited to the benefit of non-invasive radiological methods because endovascular treatment is not relevant in the setting of osteochondroma-induced arterial pseudoaneurysm.

Management of a case of ruptured pseudoaneurysm and stenosis of femoral artery caused by femoral osteochondroma

We present a rare case of ruptured pseudoaneurysm of distal femoral artery due to osteochondroma in a 21-year- old male. The patient was initially treated for osteochondroma as ruptured pseudoaneurysm was not suspected. Diagnosis of ruptured pseudoaneurysm could only be made intraoperatively when rent in the femoral artery was found along with surrounding hematoma and obstruction in the distal femoral artery. Patient underwent multiple surgeries (resection of osteochondroma and femoro-popliteal bypass) and recovered well with palpable pulsations in the operated limb.

Idiopathic popliteal artery pseudoaneurysm: emergency diagnosis and treatment

Pseudoaneurysms or false aneurysms of the popliteal artery are uncommon arterial disorders. These disorders most commonly result from trauma and iatrogenic lesions following orthopedic procedures. The authors report a rare case of popliteal artery pseudoaneurysm in which etiology was unknown. The authors also demonstrate that Doppler ultrasonography may be sufficient for planning vascular surgical procedures and that the open surgical approach is the treatment of choice for cases in which the symptomatic lesion causes local compression.