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Ben Mrad I, Ben Salah R, Ben Mrad M, Miri R, Haddad A, Mleyhi S, Zairi I, Hamza K, Jrad M, Denguir R. Hybrid Management of a Pseudoaneurysm of the Inferior Gluteal Artery Following a Stab Wound. Open Access Emerg Med 2021; 13:319-323. [PMID: 34321933 PMCID: PMC8313107 DOI: 10.2147/oaem.s312083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Aneurysms and pseudoaneurysms of the gluteal artery are rare. They represent less than 1% of the described arterial aneurysms. Those that touch the inferior gluteal artery are even rarer. Only a few cases have been described worldwide. Such cases often present with a variable time course, mode of injury, and associated symptoms, leading to their misdiagnosis and improper treatment. We present the case of a 30-year-old male, who presented to our emergency room one week after a stab wound in the left gluteal region causing a pseudoaneurysm of the left inferior gluteal artery with a sciatic compartment syndrome treated by a hybrid approach.
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Affiliation(s)
| | - Ramy Ben Salah
- Plastic Surgery Department, Bizerte Hospital, Tunis, Tunisia
| | - Melek Ben Mrad
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Rim Miri
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Anis Haddad
- General Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Sobhi Mleyhi
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Ihsen Zairi
- Cardiology Department, Hbib Thameur Hospital, Tunis, Tunisia
| | - Khalil Hamza
- Radiology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mariem Jrad
- Radiology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Raouf Denguir
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
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2
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Coste M, Yoon D, Noory M, Roudnitsky V. Superior gluteal artery pseudoaneurysm after a gunshot wound to the buttock: A case. Int J Surg Case Rep 2020; 77:341-344. [PMID: 33212307 PMCID: PMC7683236 DOI: 10.1016/j.ijscr.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/05/2022] Open
Abstract
Gunshot and stab wounds are common causes of penetrating trauma to the buttock. Penetrating trauma to the upper zone of the buttock can result in vascular injury. Pseudoaneurysms are rare complications of traumatic arterial injuries. Pseudoaneurysms can be treated with embolization. There are no guidelines for screening of gluteal pseudoaneurysms after trauma.
Introduction Penetrating trauma to the buttock can rarely result into the development of a gluteal artery pseudoaneurysm. Here we present the case of a patient with a superior gluteal pseudoaneurysm after a gunshot wound to the left buttock. Presentation of case A 48-year-old male presented with fullness and tenderness at the left gluteal wound that resulted from a gunshot 18 days prior. At the time of initial trauma, imaging showed minimal extravasation of contrast at the left superior gluteal artery, but the bleeding stopped and patient was discharged. On his return, examination showed palpable fluctuance but no bleeding. A superior gluteal artery pseudoaneurysm was identified on CT scan. Patient also complained of intermittent subjective fever and new onset of SOB. CT chest demonstrated a pulmonary embolism at the right basilar segmental artery. Coil embolization was performed to treat the pseudoaneurysm and patient was subsequently started on anticoagulation therapy. Discussion Penetrating wounds to the buttock can result in associated vascular or visceral injuries. Pseudoaneurysms can develop days to years after the initial injury. On exam, presence of pain, swelling, tenderness, bleeding from wound, thrill, bruit or a pulsating mass should raise suspicion for pseudoaneurysm, which can be diagnosed on CT scan and treated with embolization. Conclusion Proper management of traumatic wounds to the buttock with associated vascular injuries, with follow up protocols and patient education is necessary to prevent life-threatening complications such as hemorrhage from pseudoaneurysm.
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Affiliation(s)
- Marine Coste
- SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Dosuk Yoon
- Kings County Hospital, Department of Trauma/Acute Care Surgery, Brooklyn, NY, USA; Wyckoff Heights Medical Center, Department of Surgery, Brooklyn, NY, USA
| | - Mary Noory
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Valery Roudnitsky
- SUNY Downstate Medical Center, Brooklyn, NY, USA; Kings County Hospital, Department of Trauma/Acute Care Surgery, Brooklyn, NY, USA
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3
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Costa RF, Yoshida RDA, Gibin RJ, Sobreira ML, Pimenta REF, Bertanha M, de Camargo PAB, Yoshida WB. Inferior gluteal artery pseudoaneurysm after fall from a bicycle: case report. J Vasc Bras 2018; 17:353-357. [PMID: 30787957 PMCID: PMC6375272 DOI: 10.1590/1677-5449.003018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pseudoaneurysms of gluteal arteries are rare, especially involving the inferior gluteal artery. They are mainly associated with penetrating trauma, infections, or pelvic fractures. A minority of cases are caused by blunt traumas, with only six cases reported in English. We present a case of pseudoaneurysm of the right inferior gluteal artery after a bicycle fall, presenting with a large hematoma in the gluteal region, observed during clinical examination, and significantly reduced hemoglobin. CT angiography revealed a large hematoma, with contrast extravasation and pseudoaneurysm formation. Angiography revealed that the origin of the lesion was in the right inferior gluteal artery. This artery was embolized with coils. After the procedure, the patient was referred to an intensive care unit, from where he was later transferred to a different hospital, with bleeding controlled. Endovascular treatment of these cases is a safe, fast and an effective option.
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Affiliation(s)
| | - Ricardo de Alvarenga Yoshida
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Rodrigo Jaldin Gibin
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Marcone Lima Sobreira
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Rafael Elias Fares Pimenta
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Matheus Bertanha
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Paula Angeleli Bueno de Camargo
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Winston Bonetti Yoshida
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
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4
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First Case of 2 Synchronous Gluteal Arteries Aneurysms Treated by Endovascular Plug Embolization: Case Report and Literature Review. Ann Vasc Surg 2017; 47:282.e1-282.e5. [PMID: 28963047 DOI: 10.1016/j.avsg.2017.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/03/2017] [Accepted: 09/14/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Gluteal artery aneurysms (GAAs) are rare, accounting for less than 1% of all arterial aneurysms. Most of them are post-traumatic in nature and involve the superior gluteal artery (SGA), while injuries of the inferior gluteal artery (IGA) have been reported less frequently. We report an unusual case of a patient with double saccular GAA of unknown etiology, involving both the SGA and IGA, successfully treated by endovascular embolization. CASE REPORT A 80-year-old man referred to our hospital complaining of the progressive onset of left buttock pain and swelling exacerbated by sitting position in the last 4 months. His past medical history was positive for hypertension, prostatic adenocarcinoma treated by brachytherapy, and endocarditis diagnosed about 30 years before and treated by cardiac surgical valve replacement; no history of trauma was reported. After ultrasonography was carried out, an enhanced computed tomography (CT) scan confirmed the presence of 2 large GAAs involving both the SGA and IGA, with maximum transverse diameter of 38 and 84 mm, respectively. The patient was referred for endovascular treatment after informed consent was provided. After sequential selective catheterization of SGA and IGA, 3 Amplatzer Plugs II (St. Jude Medical, Zaventem, Belgium) were deployed inside the aneurysms. Postoperative course was uneventful as buttock pain completely disappeared on the second postoperative day. The patient was discharged to home on the third postoperative day. One-month CT scan confirmed the complete thrombosis of the aneurysms without any endoleak. CONCLUSIONS GAAs represent a rare pathology, and for that reason, the correct timing and choice of treatment are not clearly defined. Endovascular techniques are the first step in the approach to GAAs. In case of complex anatomy, GAAs embolization by the use of vascular plugs can be successfully performed.
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5
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Collinge CA, Ziran NM, Coons DA. Relationship Between the Superior Gluteal Vessels and Nerve at the Greater Sciatic Notch. Orthopedics 2015; 38:e929-33. [PMID: 26488790 DOI: 10.3928/01477447-20151002-62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/06/2015] [Indexed: 02/03/2023]
Abstract
Bleeding from the superior gluteal (SG) blood vessels at the greater sciatic notch is frequently encountered during acetabular fracture surgery. The purpose of this study is to define the positional anatomy of the superior gluteal vessels and nerve (SGVAN) at the greater sciatic notch. Twenty-three hemipelvi were dissected in whole human cadavers. The greater sciatic notch and SGVAN were visualized via a posterior surgical approach, identified deep in the greater sciatic notch, and traced superficially. Branches of the SGVAN and their anatomical relationship to each other were recorded. In the notch, SG arteries comprised a single vessel in 18 (78%) of 23 specimens, with all of these dividing at varying distances (1-3.5 cm) along the lateral ilium after dividing into superior and inferior branches. The SG artery branches were contiguous with periosteum of the bony notch in all specimens. More than 1 SG nerve branch was seen in the greater sciatic notch of all specimens, including an inferior branch that exited caudal or caudal-superficial to the SG vessels. The caudal-most SG nerve branch was directly adjacent to the bony notch's periosteum in 15 (65%) of 23 specimens. The SGVAN are at risk in patients undergoing acetabular fracture surgery. Individuals performing surgery along the acetabulum's posterior column would expect to encounter a major SG nerve branch (deep inferior) before encountering the SG vessels in all cases. Iatrogenic injuries to the SGVAN might be prevented by avoiding use of cautery in this area if hemorrhage is encountered.
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6
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Saad PF, Saad KR, Armstrong DMFDO, Soares BLDF, de Almeida PHF, Razuk Filho Á. Inferior gluteal artery pseudoaneurysm related to intramuscular injection. Int J Surg Case Rep 2014; 6C:29-32. [PMID: 25506847 PMCID: PMC4334878 DOI: 10.1016/j.ijscr.2014.10.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 12/01/2022] Open
Abstract
A case of pseudoaneurysm of the IGA following intramuscular injection in the buttock. Importance careful physical examination in order to avoid misdiagnosis. Diagnosis and therapy are facilitated by catheter angiography.
INTRODUCTION Gluteal artery pseudoaneurysms are rare, yet the most common in cases involving the superior gluteal artery. Pseudoaneurysms of the inferior gluteal artery are uncommon and are often related to blunt or penetrating trauma, infections and fractures of the pelvis. PRESENTATION OF CASE The authors present a case of pseudoaneurysm of the inferior gluteal artery related to an iatrogenic injury due to intramuscular injection of medication, which was treated with selective embolization of the artery during angiography. DISCUSSION The most common manifestation of an inferior gluteal artery pseudoaneurysm is the presence of a painful mass in the buttock that may or may not be associated with neurological symptoms due to compression of the sciatic nerve. Ultrasound with color Doppler and computerized tomography with multi-detectors are useful non-invasive tools for diagnosis. However, both diagnosis and therapy are facilitated by catheter angiography. CONCLUSION This case cautions that although pseudoaneurysms are rare, pseudoaneurysms of the inferior gluteal artery require a high index of suspicion and careful physical examination by the physician in order to avoid misdiagnosis. It also illustrates the usefulness of a minimally invasive modality for treatment of these lesions.
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Affiliation(s)
- Paulo Fernandes Saad
- School of Medicine of Vale do São Francisco Federal University, Av. José de Sá Maniçoba, s/n, Centro, Petrolina 56304917, PE, Brazil
| | - Karen Ruggeri Saad
- School of Medicine of Vale do São Francisco Federal University, Av. José de Sá Maniçoba, s/n, Centro, Petrolina 56304917, PE, Brazil.
| | | | - Bruno Leonardo de Freitas Soares
- School of Medicine of Vale do São Francisco Federal University, Av. José de Sá Maniçoba, s/n, Centro, Petrolina 56304917, PE, Brazil
| | - Paulo Henrique Freitas de Almeida
- School of Medicine of Vale do São Francisco Federal University, Av. José de Sá Maniçoba, s/n, Centro, Petrolina 56304917, PE, Brazil
| | - Álvaro Razuk Filho
- Holy House Medical Sciences Faculty of São Paulo, Rua Dr. Cesário Motta Jr., 61, São Paulo 01221020, SP, Brazil
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7
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Abstract
Clinical research on penetrating injury to the buttock is sparse and largely limited to case reports and clinical series. The purpose of this paper is to provide a detailed overview of literature of the topic and to propose a basic algorithm for management of penetrating gluteal injuries (PGI). MEDLINE, EMBASE, Cochran, and CINAHL databases were employed. Thirty-seven papers were selected and retrieved for overview from 1,021 records. PGI accounts for 2-3 % of all penetrating injuries, with a mortality rate up to 4 %. Most haemodynamically stable patients will benefit from traditional wound care and selective non-operative management. When gluteal fascia injury is confirmed or suspected, a contrast-enhanced CT-scan provides the most accurate injury diagnosis. CT-scan-based angiography and endovascular interventions radically supplement assessment and management of patients with penetrating injury to the major buttock and adjacent extra-buttock arteries. Immediate life-saving damage-control surgery is indicated for patients with hypovolemic shock and signs of internal bleeding. A universal basic management algorithm is proposed. This overview shows that penetrating injury to the buttock should be regarded as a potential life-threatening injury, and therefore, patients with such injuries should be managed in trauma centres equipped with hybrid operating theatres for emergency endovascular and open surgery for multidisciplinary teams operating 24/7.
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8
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Mouawad NJ, Haurani MJ, Mason T, Satiani B. Delayed presentation and management of blunt traumatic inferior gluteal artery pseudoaneurysm with associated arteriovenous fistula. Vasc Endovascular Surg 2013; 47:573-6. [PMID: 23883787 DOI: 10.1177/1538574413497272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disruption of arterial wall integrity as a result of trauma, iatrogeny, inflammation, or infection may result in pseudoaneurysm formation. Gluteal artery aneurysms are rare and represent less than 1% of all arterial aneurysms. Pseudoaneurysms of the inferior gluteal artery (IGA) following blunt trauma are exceptionally rare with only 6 reported cases in the English literature. We describe an 82-year-old female with a remote history of a fall presenting with an enlarging buttock mass. Imaging confirmed an IGA pseudoaneurysm with associated arteriovenous fistula that was successfully treated with endovascular embolization.
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Affiliation(s)
- Nicolas J Mouawad
- 1Division of Vascular Diseases & Surgery, Department of Surgery, The Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA
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9
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Traumatic inferior gluteal artery pseudoaneurysm with compressive neuropathy managed with endovascular embolization and surgery. Cardiovasc Intervent Radiol 2013; 37:275-7. [PMID: 23354965 DOI: 10.1007/s00270-013-0552-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 12/14/2012] [Indexed: 02/05/2023]
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10
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Embolization of pelvic arterial injury is a risk factor for deep infection after acetabular fracture surgery. J Orthop Trauma 2013; 27:11-5. [PMID: 22495529 DOI: 10.1097/bot.0b013e31824d96f6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether embolization of pelvic arterial injuries before open reduction and internal fixation (ORIF) of acetabular fractures is associated with an increased rate of deep surgical site infection. METHODS Retrospective review of patients who underwent ORIF of acetabular fractures at our institution from 1995 through 2007 (n = 1440). We compared patients with acetabular fractures who underwent angiography and embolization of a pelvic artery (n = 12) with those who underwent angiography but did not undergo embolization (n = 14). Primary outcome was presence of infection requiring return to the operating room. RESULTS Seven (58%) of the 12 patients who underwent embolization developed deep surgical site infection compared with only 2 (14%) of the patients who underwent angiography but did not require pelvic vessel embolization (P < 0.05, Fisher exact test). CONCLUSIONS The combination of an acetabular fracture that requires ORIF and a pelvic arterial injury that requires angiographic embolization is rare. However, the 58% infection rate of the patients who underwent embolization before ORIF is an order of magnitude higher than typical historical controls (2%-5%) and significantly higher than that of the control group of patients who underwent angiography without embolization (14%). In addition, a disproportionate number of the patients who developed infection had their entire internal iliac artery embolized. Surgeons should be aware that embolization of a pelvic arterial injury is associated with a high rate of infection after subsequent ORIF of an acetabular fracture. Embolization of the entire iliac artery should be avoided whenever possible. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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11
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Sciatic Nerve Compression Resulting From Posttraumatic Pseudoaneurysm of the Superior Gluteal Artery: A Case Report and Literature Review. ACTA ACUST UNITED AC 2009; 66:1731-4. [DOI: 10.1097/01.ta.0000242215.42642.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Zhang Q, Liu H, Smith WR, Pan J, Chen W, Zhang Y. Blunt injury to the inferior gluteal artery: case report of a rare "near miss" event. Patient Saf Surg 2008; 2:27. [PMID: 18959806 PMCID: PMC2585072 DOI: 10.1186/1754-9493-2-27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 10/29/2008] [Indexed: 11/10/2022] Open
Abstract
Traumatic injuries of the inferior gluteal artery are rare, the majority of which are aneurysms due to sharp or blunt trauma. We report the rare case of a "near miss" event of a patient with an acute hemorrhagic mass in the right buttock caused by blunt trauma to the inferior gluteal artery without "hard" clinical signs of vascular injury. Despite the unusual presentation, diffuse injury of the inferior gluteal artery branches was diagnosed by ultrasonography and angiography. This article highlights the importance of considering an arterial injury following blunt trauma to the buttock with subsequent pain and swelling. Appreciation of this rare injury pattern is necessary in order to facilitate rapid diagnosis and appropriate treatment.
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Affiliation(s)
- Qi Zhang
- Department of Orthopaedics, 3rd Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, PR China.
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13
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Singh V, Sharma H, Maini L. Inferior gluteal artery pseudoaneurysm mimicking gluteal abscess. Indian J Surg 2007; 69:257-9. [PMID: 23132999 DOI: 10.1007/s12262-007-0038-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022] Open
Abstract
We report a case of pseudoaneurysm of inferior gluteal artery initially diagnosed as gluteal abscess. Pseudoaneurysms of inferior gluteal artery are rare. High degree of clinical suspicion is required in a patient presenting with a post-traumatic swelling in the gluteal region. These aneurysms may present with very different clinical pictures. They can be diagnosed by Doppler ultrasound, computed tomography or magnetic resonance imaging. Mainstay of the diagnosis is by angiography and the preferred management with good clinical results is with angiographic embolisation.
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Affiliation(s)
- Vikas Singh
- Maulana Azad Medical College and associated Lok Nayak and GB Pant Hospital, New Delhi, India
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14
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Roganović Z, Mišović S, Kronja G, Savić M. Peripheral nerve lesions associated with missile-induced pseudoaneurysms. J Neurosurg 2007; 107:765-75. [DOI: 10.3171/jns-07/10/0765] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Reports of traumatic pseudoaneurysms associated with nerve compression are rare, and typically do not focus on the damaged nerves. This prospective study examines the clinical presentation, management, and treatment outcome of such nerve injuries.
Methods
Between 1991 and 1995, 22 patients with a missile-induced nerve injury associated with a pseudoaneurysm were treated surgically at the Belgrade Military Medical Academy. The artery and nerves involved with the injury were treated using appropriate surgical procedures, and both the sensorimotor deficit and pain intensity were assessed.
Results
The occurrence of a pulsatile mass depended on the location of the pseudoaneurysm (p = 0.003) and correlated significantly with the preoperative diagnosis (p < 0.001). In cases in which neurological worsening was due exclusively to the compressive effect of the pseudoaneurysm, the nerves involved were found to be in anatomical continuity intraoperatively, and recovery depended on the actual nerve damage and surgical procedure required (neurolysis or nerve grafting). A symptomatic nerve compression duration of more than 3.5 days was the critical factor that determined if neurapraxia developed into severe nerve damage (p = 0.014). Pain syndromes responded well and rapidly to the surgical treatment (p < 0.001).
Conclusions
Whether or not a missile-induced pseudoaneurysm associated with a nerve lesion will be recognized before surgery depends on its location and clinical presentation. The nerves involved almost invariably exhibit a lesion in continuity, but the resulting nerve damage can be severe, particularly if surgery is delayed for more than 3 to 4 days after neurological worsening has begun. A successful outcome may be expected if an appropriate surgical technique (neurolysis or grafting) is chosen on the basis of the intraoperative discovery of nerve action potentials.
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Affiliation(s)
| | - Sidor Mišović
- 2Vascular Surgery, Military Medical Academy, Belgrade, Serbia
| | - Goran Kronja
- 2Vascular Surgery, Military Medical Academy, Belgrade, Serbia
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15
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Lee D, Legiehn GM, Munk PL. Pseudoaneurysm of the superior gluteal artery following polytrauma. Skeletal Radiol 2007; 36:875-8. [PMID: 17410354 DOI: 10.1007/s00256-007-0289-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 01/03/2007] [Accepted: 02/02/2007] [Indexed: 02/02/2023]
Abstract
Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis.
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Affiliation(s)
- Dennis Lee
- University of British Columbia and Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada.
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16
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Keeling AN, Naughton PA, Leahy AL, Lee MJ. Traumatic inferior gluteal artery pseudoaneurysm and arteriovenous fistula managed with emergency transcatheter embolization. Cardiovasc Intervent Radiol 2007; 31 Suppl 2:S135-9. [PMID: 17710471 DOI: 10.1007/s00270-007-9150-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 06/15/2007] [Accepted: 06/23/2007] [Indexed: 10/22/2022]
Abstract
We present a case of blunt trauma to the buttock resulting in an inferior gluteal artery pseudoaneurysm and arteriovenous fistula. The characteristic diagnostic features on CT angiography and digital subtraction angiography (DSA), along with the emergency percutaneous management of this traumatic vascular injury, are described. A review of the literature demonstrates inferior gluteal artery pseudoaneurysm is a rare condition, while successful treatment with glue embolization is previously unreported.
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Affiliation(s)
- A N Keeling
- Department of Academic Radiology, Beaumont Hospital, Dublin 9, Ireland
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17
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Aydin A, Lee CC, Schultz E, Ackerman J. Traumatic inferior gluteal artery pseudoaneurysm: case report and review of literature. Am J Emerg Med 2007; 25:488.e1-3. [PMID: 17499680 DOI: 10.1016/j.ajem.2006.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Accepted: 11/27/2006] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ani Aydin
- SUNY Stony Brook School of Medicine, Stony Brook, NY 11794, USA
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18
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Berthelot JM, Pillet JC, Mitard D, Chevalet-Muller F, Planchon B, Maugars Y. Buttock claudication disclosing a thrombosis of the superior left gluteal artery: Report of a case diagnosed by a selective arteriography of the iliac artery, and cured by per-cutaneous stenting. Joint Bone Spine 2007; 74:289-91. [PMID: 17369072 DOI: 10.1016/j.jbspin.2006.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 06/16/2006] [Indexed: 11/21/2022]
Abstract
We report on a case of left buttock claudication, occurring consistently after 150 meters walking, and disappearing after a short rest. As magnetic resonance angiography (MRA) did not show any explanation for this claudication, a selective angiography of left internal iliac artery was requested, which clearly identified a tight stenosis of the onset of the left superior gluteal artery. A per-cutaneous angioplasty together with stenting of this artery, induced a prompt and complete relief of pain at the three months follow-up visit.
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Affiliation(s)
- Jean-Marie Berthelot
- Service de Rhumatologie, Hôtel-Dieu, CHU Nantes, 1, Place Alexis, 44093 Nantes Cedex 01, France.
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Pseudoaneurismas de la arteria glútea superior. A propósito de un caso y revisión de la bibliografía. ANGIOLOGIA 2006. [DOI: 10.1016/s0003-3170(06)75003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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