Iatrogenic profunda femoris artery pseudoaneurysm: late presentation with successful endovascular microcoil embolisation

Silent iatrogenic pseudoaneurysm after intertrochanteric fracture fixation with proximal femoral nailing and cerclage wiring: case report and review of literature

Pseudoaneurysm is a rare complication after intertrochanteric fracture fixation. Herein, we present a rare case of late development of a pseudoaneurysm with silent clinical symptoms. The case was a 91-year-old woman treated with proximal femoral nailing and cerclage wiring. Postoperatively, the patient was able to ambulate with a walker without abnormal symptoms. During the follow-ups, the radiographic images showed progressive cortical scalloping on the medial femoral shaft. Ultrasonography revealed a yin-yang sign, and a CT scan confirmed a pseudoaneurysm at the profunda femoris artery (PFA). In this case, many possible causes of pseudoaneurysm were hypothesized. We showed that the excessive displaced, long spiral pattern of an intertrochanteric fracture, which was irreducible by a closed technique, is the risk of a PFA injury. An atherosclerotic vessel was seen in preoperative radiography, indicating poor vessel elasticity which may be a risk of vessel tear during fracture reduction using multiple reduction instruments in excessive displaced fracture. Moreover, over-penetration when drilling should not be overlooked. We also discuss the predisposing factors, surgical techniques which may lead to this type of PFA injury and summarize the literature of pseudoaneurysms related to intertrochanteric fracture fixation.

Misery of Orthopaedic Surgeon: Delayed Diagnosis of Pseudoaneurysm of Profunda Femoris Artery Following Fixation of Intertrochanteric Femoral Fracture: A Case Report and Review of Literature

INTRODUCTION

Pseudoaneurysm of profunda femoris artery is an uncommonly reported vascular mishap after orthopedic procedures around proximal femur. Diagnostic dilemma and resulting delay are quite common due to varied clinical presentations.

CASE PRESENTATION

Herein, we report a case of a 65-year-old lady who was diagnosed in our institution with pseudoaneurysm of profunda femoris artery 3 months after getting operated for intertrochanteric fracture of right femur in a private hospital. She started having gradually enlarging painful thigh swelling of the involved limb 1 month after operation. She also developed concurrent weakness, anemia, and received multiple blood transfusions before being referred to our institution. Diagnosis was clinched with duplex ultrasound imaging and subsequent digital subtraction angiography with coil embolization was performed. She made an uneventful and speedy recovery, and doing well till the last follow-up.

CONCLUSION

Timely diagnosis is paramount to avoid limb- and life-threatening sequelae; surgeons should keep strong vigil to administer the timely intervention. Various preventive strategies during fixation of intertrochanteric fracture should be deployed to keep this untoward entity in abeyance.