Posterior tibial artery aneurysm: a case report with review of literature

Spontaneous bilateral superficial femoral artery pseudoaneurysms and a unilateral posterior tibial artery aneurysm in an immunocompromised patient

Key Clinical Message

The presence of multiple pseudoaneurysms in a patient should prompt investigations for the underlying etiologies including autoimmune and immunosuppressive disease processes. Treatment options include open repair and endovascular stenting.

Abstract

Pseudoaneurysms (also known as false aneurysms) are atypical dilatations or outpouchings from a vessel which are not always contained by the three layers of a normal vessel wall, namely the intima, media, and adventitia. These are distinct from a true aneurysm which has a wall comprising all three layers. The underlying etiology for both true aneurysms and pseudoaneurysm can vary. We present the rare case of bilateral superficial femoral artery pseudoaneurysms, of unknown etiology and a concurrent posterior tibial artery saccular aneurysm in a patient with Human Immunodeficiency Virus (HIV) infection and multiple comorbidities. This was managed using a combination of endovascular covered stent grafts and open surgical repair technique. The patient is doing well on follow-up a year later with no post-operative infections. A literature review of the existing reports of superficial femoral artery pseudoaneurysms and posterior tibial artery aneurysms and their management is also reported.

Posterior Tibial Artery Aneurysm Caused by Trauma: A Case Report

In this study, we present a case of 59-year-old man with a posterior tibial artery (PTA) aneurysm. Mostly, PTA aneurysm is caused by trauma, infection, and iatrogenic injury. The patient had a history of ankle trauma that occurred 2 years ago. Computed tomography and ultrasonography showed a 7×14 mm PTA aneurysm. The aneurysm was resected and primary end-to-end anastomosis was performed. So far, there are only few reported cases of PTA aneurysm. Herein, we describe the surgical strategy and provide detailed intraoperative images.

Spontaneous pseudoaneurysm of the posterior tibial artery successfully treated by open surgery: Case report and review of the literature

RATIONALE

An extremely rare spontaneous pseudoaneurysm (PSA) of the posterior tibial artery (PTA) in a middle-aged male patient was cured by open surgery effectively.

PATIENT CONCERNS

A 53-year-old man presented with the increasing swollen left shank for 1 day, with intermittent pain, pulselessness and pallor. He denied the history of trauma, infection, and other diseases.

DIAGNOSES

Physical examination, past medical history, ankle brachial index, ultrasonography, computed tomographic angiography (CTA), 3-dimensional reconstruction image of the popliteal artery and its branches and histological examination of intraluminal thrombus and clots helped us diagnose the patient as spontaneous PSA of PTA.

INTERVENTIONS

Our patient underwent excision of PSA and repair operation of PSA.

OUTCOMES

The patient recovered well at 2-year follow-up.

LESSONS

This rare case provides valuable insights for tissue repair and vascular surgery. Therapeutic methods should be in accordance with the best interest of patient. Open surgery is the effective treatment for spontaneous PSA of PTA.

A Rare Case of Bilateral Posterior Tibial Artery Aneurysm Presenting as Unilateral Acute Limb Ischemia

True aneurysms of the tibial arteries are extremely rare. Of the few previously described tibial artery aneurysms, there are scant reports of isolated true aneurysms of the posterior tibial artery (PTA). In this report, we describe the second documented case of bilateral true PTA aneurysms. Unique aspects of this case are that the aneurysmal PTA were the only patent tibial arteries bilaterally, the aneurysms were degenerative in nature, and initial patient presentation was due to aneurysm thrombosis causing acute foot ischemia. The clinical and radiological features of this case, as well as surgical decision making and management, are discussed.

Septic True Aneurysm of the Posterior Tibial Artery Diagnosed after Anterior Arthroscopic Debridement of a Septic Ankle following Infective Endocarditis: A Case Report

Introduction

There have been reports of true aneurysm of the posterior tibial artery, but only three reports have described true aneurysm of the posterior tibial artery at the ankle, and there has been only one report of tarsal tunnel syndrome caused by true aneurysm of this artery. In this case report, we describe a rare case of true septic aneurysm of the posterior tibial artery presenting as tarsal tunnel syndrome which was found after anterior arthroscopic debridement of a septic ankle in a 55-year-old man.

Case Report

13 years earlier, this patient had undergone aortic valve replacement for severe aortic regurgitation caused by infective endocarditis with aortic valve vegetations. Since then, the patient had been treated with the oral anticoagulant warfarin. The aneurysm was successfully treated by a saphenous vein graft and administration of antibiotics. The patient likely developed septic ankle and aneurysm as a consequence of infective endocarditis.

Conclusions

Magnetic resonance imaging should be performed before arthroscopic surgery to rule outaneurysm, especially in a patient with a septic ankle and/ora history of infective endocarditis.

Bilateral peroneal artery aneurysms

True aneurysm of the tibial arteries is a rare clinical condition. We report the case of a 67-year-old man who presented with a gradual onset of right calf swelling and pain. Imaging revealed large aneurysms arising from the proximal peroneal arteries bilaterally, measuring 7.4cm and 4cm on the right and left respectively. A detailed medical history, clinical examination and laboratory investigations did not identify evidence of an underlying cause. A surgical reconstruction with an interposition vein graft was successfully performed. To our knowledge, this is the first reported case of primary aneurysm of the peroneal artery in the English literature. We undertook a systematic literature review to identify all reported cases of primary aneurysms of the tibial arteries. The clinical presentation, modes of investigation and interventional treatments are discussed.

Clinical features of a rare anatomical variation of the posterior tibial and fibular arteries

The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual “X” format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.

Nonunion of the tibial facture as a consequence of posterior tibial artery pseudoaneurysm

Pseudoaneurysm of the posterior tibial artery (PTA) is uncommon, and they mainly occur following high-velocity trauma, open fractures and can be iatrogenic in nature. To the best of our knowledge, this is the first reported and successfully treated case of PTA pseudoaneurysm identified as a consequence of tibia fracture nonunion in an otherwise healthy young individual 6 months following the original incident with a novel intraoperative technique.