Pseudo-aneurysm of the anterior tibial artery, a rare cause of ankle swelling following a sports injury

Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player

Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy.

Pseudoaneurysms after Ankle Sprain: Report of Three Cases Successfully Cured by Nonsurgical Treatment

Pseudoaneurysm is a rare complication of ankle sprain, with 18 case reports published in the current literature. In the vast majority of the cases, they were treated surgically. We present 3 cases of pseudoaneurysm following ankle sprain, treated by nonsurgical methods in 2 cases, and spontaneously healed in another. The diagnosis was made between 2 and 4 weeks after traumatism, by ultrasonography and arteriography in 2 cases, and only by ultrasonography in a third case. The pseudoaneurysms originated respectively from the perforating fibular artery, the dorsal pedis artery, and a lateral malleolar artery. Largest diameters of the pseudoaneurysms ranged from 2.4 to 6 cm. Patients were successfully treated by thrombin injection in a case and by coil embolization in another. Spontaneous thrombosis was demonstrated at follow-up in the third case. These cases suggest that a nonsurgical treatment can be considered for pseudoaneurysms complicating ankle sprains.

[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.

Pseudoaneurysms around the foot and ankle: case report and literature review

Pseudoaneurysms developing around the foot and ankle are known to be an uncommon complication following surgery. We present a case of a pseudoaneurysm following ankle surgery for a tibial plafond fracture and comprehensively review the literature with emphasis on their anatomic location, aetiology and treatment options.

Blunt trauma of the anterior tibial artery in professional footballers

Three cases of blunt trauma to the anterior tibial artery in professional footballers are described. Each case was managed conservatively, allowing the players to promptly return to competitive fixtures. We hope the outcomes of the cases described might be helpful for teams facing the challenge of managing similar injuries.

Delayed posttraumatic pseudoaneurysm of the anterior tibial artery mimicking a malignant tumor

The anterior tibial artery arises at the lower border of the popliteus muscle, and passes anteriorly to lie on the interosseous membrane medial to the fibular neck. Injury to the artery results in extravasation of blood, and the tamponade effect of the surrounding tissue may contain acute hemorrhage. The blood clot gradually liquefies resulting in the formation of a fibrous capsule. Consequently, a pseudoaneurysm contains no normal elements of arterial wall, as opposed to a true arterial aneurysm. Pseudoaneurysm of the anterior tibial artery has been reported as a complication of fracture surgery and is usually felt to be iatrogenic. It has occurred following a fracture treated without surgery and may be related to the vessel being tethered by the fascia and interosseous membrane. It has also been reported in cases of blunt trauma to the leg without fracture, and as well following elective orthopedic procedures. We report the case of a patient 7 months following open reduction and plate fixation of a fracture of the distal third of the tibial shaft, who presented with a large painful proximal leg mass thought to be a malignant tumor. Three previous such presentations have been found in the literature and illustrates the importance of suspecting a delayed vascular injury following lower leg trauma. Duplex ultrasound examination should be performed initially to avoid an inadvertent incision and catastrophic bleeding as might occur with an inappropriate biopsy. Preoperative and intraoperative angiograms are essential to confirm the diagnosis, delineate the site and type of injury, and help to plan the treatment.