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Kume N, Konagaya K, Okamoto T, Ogino H. A Case of Profunda Femoris Artery Pseudoaneurysm Treated With Catheterization and Surgical Hematoma Removal. Cureus 2023; 15:e42708. [PMID: 37654926 PMCID: PMC10465818 DOI: 10.7759/cureus.42708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
A pseudoaneurysm of the profunda femoris artery (PFA) is a rare disease induced by femoral trauma, proximal femoral fracture, or iatrogenic causes associated with orthopaedic surgery. Recently, transcatheter arterial embolism was reported as an effective treatment for profunda femoris artery pseudoaneurysm. This report presents the case of an 85-year-old male who underwent artificial head replacement for a left femoral neck fracture and was hospitalized with a peri-stem fracture four years later. Conservative treatment was conducted with a brace, though the swelling and pain in his left thigh increased one week after his hospital admission. Contrast-enhanced computed tomography (CT) led to a diagnosis of a left profunda femoris artery pseudoaneurysm, and the patient underwent emergency transcatheter arterial embolism and surgical hematoma removal. Since the emergency surgery, the patient's course has been good, and he has been undergoing rehabilitation.
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Affiliation(s)
- Nao Kume
- Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, JPN
| | | | - Takashi Okamoto
- Cardiovascular Surgery, Narita Tomisato Tokusyukai Hospital, Chiba, JPN
| | - Hidemitsu Ogino
- Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, JPN
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Samaan M, Idres FA, Hawa Y, Madania M. Late deep femoral artery injury after intertrochanteric hip fracture treatment: A case report. Int J Surg Case Rep 2023; 105:107983. [PMID: 36934650 PMCID: PMC10033936 DOI: 10.1016/j.ijscr.2023.107983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Arterial injury is a rare complication following hip fracture surgery. If not diagnosed appropriately, can lead to life- or limb-threatening situations. This report describes a case of late iatrogenic arterial injury, four weeks following surgery for intertrochanteric fracture. CASE PRESENTATION An 89-year-old woman suffered an intertrochanteric fracture. The deep femoral artery was injured four weeks after fracture treatment by dynamic hip screw, following increase of range of motion during the rehabilitation exercises. Pain and swelling increased markedly at the thigh. Slight fever with no tachycardia and the deceptive laboratory tests directed us to late-appearing sepsis. A color Doppler ultrasonography examination did not identify the arterial bleeding. Treatment was carried out to evacuate the presumed pus, but big clots were seen instead, and an active arterial bleeding was discovered. The arterial lesion was sutured and hemodynamic stability was restored. CLINICAL DISCUSSION The appearance of injury may be either acute or delayed. Unexplained laboratory results, use of beta-blockers and non-classical symptoms may be obstacles to early diagnosis of arterial injury. CONCLUSION A high index of clinical suspicion of arterial injury, even after long period after surgery, should be kept in mind. More precise investigations may be needed, as angiography, for making the diagnosis of arterial injury.
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Affiliation(s)
- Michel Samaan
- Al-Baath University, Faculty of Medicine, Homs, Syria; Syrian Association of Arthroscopy, Damascus, Syria
| | | | - Yacin Hawa
- Al-Baath University, Faculty of Medicine, Homs, Syria
| | - Marwa Madania
- Al-Baath University, Faculty of Medicine, Homs, Syria
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Muacevic A, Adler JR, Gwyn R. Iatrogenic Injury to Profunda Femoris During a Dynamic Hip Screw Fixation for Intertrochanteric Fracture. Cureus 2023; 15:e33894. [PMID: 36819373 PMCID: PMC9934907 DOI: 10.7759/cureus.33894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
We present a case of a profunda femoris artery injury during a dynamic hip screw fixation for an intertrochanteric fracture. This was identified clinically on the ward and confirmed with a CT angiogram. The bleeder was then treated by coil embolization, and laboratory results showed significant improvement in hemoglobin level after blood transfusion.
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Silent iatrogenic pseudoaneurysm after intertrochanteric fracture fixation with proximal femoral nailing and cerclage wiring: case report and review of literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03471-0. [PMID: 36585997 DOI: 10.1007/s00590-022-03471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023]
Abstract
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.
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Jun KW, Park SC, Kim SD. Aspects of iatrogenic femoropopliteal arterial injuries: Unusual vascular events. Asian J Surg 2022; 46:2013-2014. [PMID: 36357277 DOI: 10.1016/j.asjsur.2022.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kang Woong Jun
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Sang Dong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea.
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Ge J, Kong KY, Cheng XQ, Li P, Hu XX, Yang HL, Shen MJ. Missed diagnosis of femoral deep artery rupture after femoral shaft fracture: A case report. World J Clin Cases 2020; 8:2862-2869. [PMID: 32742996 PMCID: PMC7360701 DOI: 10.12998/wjcc.v8.i13.2862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/24/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vascular injury is a rare complication of femoral shaft fractures, and rupture of the deep femoral artery is more difficult to diagnose because of its anatomical location and symptoms. Despite its low incidence, deep femoral artery rupture can lead to life-threatening outcomes, such as compartment syndrome, making early identification and diagnosis critical.
CASE SUMMARY A 45-year-old male patient was admitted to our hospital due to right lower limb trauma in a car accident, with complaints of severe pain and swelling on his right thigh. X-ray demonstrated a right femoral shaft fracture. During preparation for emergency surgery, his blood pressure and blood oxygen saturation dropped, and sensorimotor function was lost. Computed tomography angiography was performed immediately to confirm the diagnosis of rupture of the deep femoral artery and compartment syndrome, so fasciotomy and vacuum-assisted closure were performed. Rhabdomyolysis took place after the operation and the patient was treated with appropriate electrolyte correction and diuretic therapy. Twenty days after the fasciotomy, treatment with the Hoffman Type II External Fixation System was planned, but it was unable to be immobilized internally based on a new esophageal cancer diagnosis. We kept the external fixation for 1 year, and 3 years of follow-up showed improvement of the patient’s overall conditions and muscle strength.
CONCLUSION For patients with thigh swelling, pain, anemia, and unstable vital signs, anterior femoral artery injury should be highly suspected. Once diagnosed, surgical treatment should be performed immediately and complications of artery rupture must be suspected and addressed in time.
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Affiliation(s)
- Jun Ge
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Ke-Yu Kong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Xiao-Qiang Cheng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Peng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Xing-Xing Hu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Hui-Lin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Min-Jie Shen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Asano Y, Yamauchi D, Gonoji Y. Evaluation of the positional relationship between femoral arteries and distal screws in the proximal femoral intramedullary nail for preventing iatrogenic vascular injury. Injury 2020; 51:384-388. [PMID: 31668355 DOI: 10.1016/j.injury.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Iatrogenic vascular injury associated with distal screw in the intramedullary nail for femoral trochanteric fracture is a rare but serious complication. This study aimed to investigate the positional relationship between distal screws and superficial (SFA), deep (DFA), and perforating femoral artery (PFA) using computed tomography (CT) angiography and to identify the risk factors of vascular injury. PATIENTS AND METHODS Thirty-eight patients (11 patients who underwent osteosynthesis with proximal femoral intramedullary nail and 27 healthy people) who underwent CT angiography were included. The distance from the great trochanter tip and insertion angle from posterior condylar axis (reference line) of the distal screws were measured, and the presence rates and distances from the femur of each artery within the insertion angle were investigated. RESULTS The distance from the great trochanter tip to the distal screw was 142.5 ± 8.8 mm. The insertion angle from the reference line was 27.3°±15° The measurement points were set at 130, 140, and 150 mm distal from the great trochanter tip, and the assumed insertion angle as 27°±15° Within this angle, the presence rates and distances were 50.8%/34.2 ± 7.0 mm (130 mm), 38.5%/34.3 ± 6.0 mm (140 mm), 30.8%/33.4 ± 6.0 mm (150 mm) in SFA; 12.3%/14.2 ± 3.3 mm (130 mm), 3.1%/13.1 ± 5.9 mm (140 mm), and 0% (150 mm) in DFA; and 0% (130-150 mm) in PFA. The presence rate of DFA increased at the posteromedial area in the thigh, and the distance from the femur became closer. CONCLUSION Within the angle that distal screws were likely to be inserted, the risk of DFA injury was the highest. Therefore, anatomical reduction of the femoral neck anteversion should be performed so that the distal screw will be inserted towards the anteromedial area in the thigh, and great attention should be paid not to over-drill the medial femoral cortex.
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Affiliation(s)
- Yohei Asano
- Department of Orthopaedic Surgery, Fukui-ken Saiseikai Hospital, 7-1, Wadanaka-machi funabashi, Fukui-shi, Fukui, 918-8503, Japan.
| | - Daisuke Yamauchi
- Department of Orthopaedic Surgery, Fukui-ken Saiseikai Hospital, 7-1, Wadanaka-machi funabashi, Fukui-shi, Fukui, 918-8503, Japan.
| | - Yukio Gonoji
- Department of Orthopaedic Surgery, Fukui-ken Saiseikai Hospital, 7-1, Wadanaka-machi funabashi, Fukui-shi, Fukui, 918-8503, Japan.
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Khanfour AA, Khanfour AA. Vascular Complications during Ilizarov Fixator Surgery to the Femur: Two Case Reports with the Introduction of a Method for Determining the Safe Vascular Corridor around the Femur. Strategies Trauma Limb Reconstr 2019; 14:106-110. [PMID: 32742423 PMCID: PMC7376588 DOI: 10.5005/jp-journals-10080-1434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim To perform an in-depth review of the safe vascular corridor around the femur in order to decrease possible vascular injury. Background Despite regular use of half pins in the femur, there is no region entirely safe for percutaneous pin placement. Damage to a major nerve or vessel must be avoided at all costs. Vascular complications during Ilizarov fixator surgery to the femur are rare but serious. Case description Of 306 cases of Ilizarov fixation to the femur in the period from 2002 to 2016, two cases had vascular complications. The first case developed a delayed superficial femoral artery (SFA) pseudoaneurysm and the second case sustained an early deep femoral artery (SFA) injury. Conclusion The in-depth review of the vascular anatomy around the femur with relevance to the placement of half pins indicates that the femoral shaft segment greatest at risk to lead to a vascular injury lies between the two points: 8 and 24 cm proximal to the adductor tubercle. How to cite this article Khanfour AA, Khanfour AA. Vascular Complications during Ilizarov Fixator Surgery to the Femur: Two Case Reports with the Introduction of a Method for Determining the Safe Vascular Corridor around the Femur. Strategies Trauma Limb Reconstr 2019;14(2):106–110.
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Affiliation(s)
- Ashraf A Khanfour
- Department of Orthopedic Surgery, Damanhour Medical National Institute, Damanhour, Egypt
| | - Ayman A Khanfour
- Department of Anatomy, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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