Posttraumatic pseudoaneurysm of popliteal artery following total knee arthroplasty

Iatrogenic popliteal artery pseudoaneurysm: A case report

BACKGROUND

Popliteal artery pseudoaneurysm is a state of vascular wall rupture in the popliteal artery. It is generally a rare situation and the most common etiologic factor is iatrogenic causes.

CASE PRESENTATION

This case report presents a successful diagnosis and management of a 31-year-old patient who was presented with a mass behind the knee, three months after femoropopliteal bypass for the treatment of a gunshot to the knee. An endovascular approach using coils was utilized for the patient, which led to complete remission for the patient.

DISCUSSION

The current patient had two primary therapeutic challenges: bleeding and hematoma growth, clot development causing blood flow restriction, and limb ischemia. Pseudoaneurysm also caused internal inflammation, which increased the risk of thrombosis and bypass graft damage during open surgery. Due to the risk of recurrence and graft damage, ultrasound-guided compression was not possible. Thus, endovascular therapy was preferred.

CONCLUSION

The endovascular approach using coils is an option for the management of PAP. However, the endovascular approach should be considered carefully according to the patient's status.

Delayed Life-Threatening Hemorrhage Caused by Cranial Tibial Artery Pseudoaneurysm in Two Dogs

Two adult dogs were presented at 25 and 30 days following tibial external skeletal fixator placement (case 1) and tibial plateau leveling osteotomy (case 2), respectively. Clinical signs at presentation for each of them included acute onset lethargy, non-weight-bearing lameness, and hemorrhage at the surgical site with large hematoma formation. On admission, emergency whole blood transfusion was required in case 2 with a preoperative packed cell volume of 13%. Both dogs were diagnosed with pseudoaneurysm of the cranial tibial artery based on color Doppler ultrasonography. Additionally, computed tomography angiography was performed in one dog. Surgical treatment of the dogs included ligation of the cranial tibial artery supplying the pseudoaneurysm and curettage of hematoma. The surgery was completed without complications in case 1, but case 2 experienced inadvertent rupture of pseudoaneurysm with significant blood loss, which required another whole blood transfusion during the procedure. Both dogs had excellent functional recovery with no recurrence of clinical signs. We hypothesized that pseudoaneurysms were primarily caused by trauma secondary to placement of surgical implants or osteotomy. For orthopedic surgeons, it is important to recognize clinical signs of a potential tibial arterial pseudoaneurysm, as early surgical intervention may prevent loss of limb or life.

Pseudoaneurysm of the Lateral Genicular Artery Following Unicompartmental knee Arthroplasty: A Rare Case Report

Introduction

Unicondylar knee replacement is a minimally invasive technique of surface replacement of the knee joint. Very little literature is available regarding vascular complications in patients who undergo this procedure due to their extremely rare nature.

Case Report

This first-of-its-kind report describes a case of pseudoaneurysm of the lateral genicular artery of the right knee in a hypertensive, 65-year-old man, following a single sitting bilateral unicompartmental knee replacement (UKR). With no involvement of the lateral compartment in UKR, we suspect an underlying mechanical element as the cause of the pseudoaneurysm. Patient presented with swelling and pain in the right knee for the first time at 8-month postoperatively, and after aspiration of the hemarthrosis, had two events of recurrence with increasing frequency. Dynamic magnetic resonance angiography confirmed the diagnosis and the patient underwent angiography-guided embolization of the lateral genicular artery using polyvinyl alcohol particles, with no recurrence in over a year since then.

Conclusion

Pseudoaneurysm of the lateral genicular artery is a possible cause of recurrent hemarthrosis even after unicondylar knee replacement and requires a high degree of suspicion for its timely diagnosis and management.

Coil embolization of an aberrant posterior tibial artery pseudoaneurysm after total knee arthroplasty

Arterial injury is a recognized but rare complication of total knee arthroplasty. These injuries, however, can be exceptionally devastating and potentially result in limb loss. Presentation may be delayed with symptoms associated with mass effect rather than with ischemia. We describe treatment of a patient with presentation delayed 2 weeks. In addition, the patient's arterial branch pattern demonstrated aberrant anatomy with high takeoff of the posterior tibial artery. This patient was successfully treated with transcatheter coil embolization. The current treatment options and published literature are reviewed.

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.

Pseudoaneurysm of the Posterior Tibial Artery following Removal of Tibial Plate- A Rare Case

Introduction:

Pseudoaneurysm is a rare complication reported after any surgery such as ORIF of fracture, plate removal, ankle or knee arthroscopy or arthroplasty. To our knowledge, pseudoaneurysms of the posterior tibial artery after tibial plate removal are a rare phenomenon. We report a case of a 18-year-old male patient who had pseudoaneurysm of posterior tibial artery following plate removal.

Case Presentation:

A 18-year-old male was referred to our outpatient clinic because of mass-like lesion in his left calf. He had a history of car accident and left isolated tibia fracture 30 months ago that was treated by open reduction and internal fixation with DCP plate. After union in radiograph, the plate was removed 7 months ago on the patient request. Four weeks after surgery, the patient had complaints of pain and swelling. Finally, pseudoaneurysm was diagnosed and was repaired in a common surgery with a vascular surgeon without any difficulty.

Conclusion:

Pseudoaneurysms of the posterior tibial artery after tibial plate removal are an extremely rare phenomenon. This complication in most cases follows penetrating injuries but it has been reported following blunt trauma. In fact, in most of these patients the diagnosis was initially missed because the large hematoma concealed the underlying pseudoaneurysm and its pulsations. Thus, a delay in the diagnosis is common in this phenomenon. Hence, the surgeon should be suspicious to this complication following plate removal when he/she is doubtful about the sign and symptoms.

Stent graft repair of anastomotic pseudoaneurysm of femoral-popliteal bypass graft following patch angioplasty

Pseudoaneurysm (PA) following vascular reconstruction is a complication of bypass surgery. Historically, the mainstay of treatment was an open repair; the surgical management consisted of resection of the initial graft with reimplantation of a new bypass either into the original arteriotomy or to a more distal target. Placement of a stent graft to exclude the PA is a viable option. We present a case of an 85-year-old man with prior history of polytetrafluoroethylene femoral-popliteal bypass now with an 8 × 5.6 cm PA of the distal anastomosis site treated with endovascular placement of a Viabahn stent.

Missed diagnosis of false aneurysm of the superficial femoral artery after closed complex fracture of the distal femur

This case report presents a 38-year-old male patient who developed a false aneurysm of the superficial femoral artery after minimally invasive plate internal fixation of a comminuted articular distal femoral fracture sustained in a motor vehicle accident. Two days after surgery, the patient developed pain, non-pulsatile swelling on the medial side of the knee and anemia. After about six weeks, diagnosis of false aneurysm of the superficial femoral artery was confirmed by duplex ultrasound and computed tomographic angiography. A percutaneous endovascular procedure was performed to treat the false aneurysm without evacuating the blood collection.