Cannulated screw for proximal tibial fracture complicated by iatrogenic popliteal pseudoaneurysm: definitive treatment by ultrasound-guided thrombin injection

Multiple Hereditary Exostoses instigating a popliteal pseudoaneurysm in a young Middle Eastern male: A case report and literature review

INTRODUCTION AND IMPORTANCE

Multiple Hereditary Exostoses is a rare autosomal dominant bone disorder that predominantly affects males at an incidence of (1:50,000 to 1:100,000) in Western populations. The etiology is owed to mutations in the EXT gene group, specifically EXT1 and EXT2 which cause the formation of Osteochondromas. Diagnosis is typically established in childhood. Nevertheless, vascular complications are extremely rare while being potentially fatal. Therefore, timely diagnosis and treatment are vital for such patients.

CASE PRESENTATION

We present the case of a 37-year-old Middle Eastern male with Multiple Hereditary Exostoses who experienced sudden-onset left lower limb pain persisting for a month prior to admission. It was associated with coldness and paresthesia of the ipsilateral lower limb. The presurgical radiological workup uncovered a popliteal pseudoaneurysm subsequent to Multiple Hereditary Exostoses.

CLINICAL DISCUSSION

Through open surgery, the vascular perfusion was successfully restored, and a subsequent supra- to infra-geniculate popliteal artery anastomosis via saphenous vein grafting was done. Furthermore, the Osteochondroma was utterly resected to limit recurrence of another vascular injury. The following histopathological analysis confirmed the diagnosis of an Osteochondroma as a result of MHE.

CONCLUSION

Multiple Hereditary Exostoses is a rare occurrence leading to pseudoaneurysms. This event underscores the need for further documentation to aid in establishing a prompt diagnosis and carrying out suitable interventions. Considering this pathology in a multidisciplinary approach ensures proper treatment. Following a comprehensive literature review, our case stands as the first case in the published literature from our country which emphasizes its value and rarity.

Pseudoaneurysm of the superior lateral genicular artery following anterior cruciate ligament repair

BACKGROUND

Pseudoaneurysm is a rare complication of surgery of the knee. The pathogenesis of false aneurysm involves partial arterial laceration, which allows hemorrhage into surrounding soft tissues that confine it. Although most cases in literature described pseudoaneurysms after total knee arthroplasty, it can be associated with arthroscopic knee surgery too.

METHODS

Here, we report an uncommon case of a false aneurysm of the superior lateral genicular artery following anterior cruciate ligament ligamentoplasty using an autograft semitendinosus-tendon.

RESULTS

Three weeks after anterior cruciate ligament repair, a 25-year old man presented with a painful swelling on his right knee. Computed tomography angiography demonstrated a false aneurysm of the superior lateral genicular artery. Ultrasound-guided percutaneous thrombin injection was performed to exclude the pseudoaneurysm, and the patient recovered well.

CONCLUSION

Pseudoaneurysm is an uncommon complication of surgery or trauma of the knee. Although most cases in literature described pseudoaneurysms after total knee arthroplasty, it can be associated with arthroscopic knee surgery too. Ultrasound-guided thrombin injection can be a valuable treatment option.

Endovascular Repair of Popliteal Artery Pseudoaneurysm With Arteriovenous Fistula After Knee Arthroscopy

We report a case of postarthroscopic popliteal artery pseudoaneurysm (PSA) with arteriovenous fistula (AVF; PSA-AVF) in a 53-year-old woman who presented with limb edema, pain, and bruit 1 year after arthroscopic meniscectomy. She was treated percutaneously by covered stent deployment. After 6 months of follow-up, the patient was asymptomatic, with patency of the stent and occlusion of the AVF. A review of the literature was also performed to investigate the prevalence of postarthroscopic PSAs and highlight the endovascular approach of treatment. Endovascular approach with covered stent appears to be less invasive and might be an effective and feasible way of treatment of postarthroscopic popliteal PSA-AVF.