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Nazari I, Zargar MA, Nazari A, Alavi SMA. Iatrogenic popliteal artery pseudoaneurysm: A case report. Int J Surg Case Rep 2024; 122:109988. [PMID: 39053369 PMCID: PMC11320411 DOI: 10.1016/j.ijscr.2024.109988] [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: 05/24/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024] Open
Abstract
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.
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Affiliation(s)
- Iraj Nazari
- Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Amin Zargar
- Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Ashkan Nazari
- Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Grand JG. Delayed Life-Threatening Hemorrhage Caused by Cranial Tibial Artery Pseudoaneurysm in Two Dogs. J Am Anim Hosp Assoc 2024; 60:74-80. [PMID: 38394694 DOI: 10.5326/jaaha-ms-7405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 02/25/2024]
Abstract
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.
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Rajani AM, Rajani K, Shah UA, Mittal ARS, Sheth R, Punamiya M. Pseudoaneurysm of the Lateral Genicular Artery Following Unicompartmental knee Arthroplasty: A Rare Case Report. J Orthop Case Rep 2022; 12:57-60. [PMID: 36687493 PMCID: PMC9831215 DOI: 10.13107/jocr.2022.v12.i08.2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/15/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Amyn M Rajani
- Department of Orthopaedic, OAKS Clinic, Mumbai, Maharashtra, India,Address of Correspondence: Dr. Amyn M Rajani, Department of Orthopaedics, OAKS Clinic, Mumbai - 400 007, Maharashtra, India. E-mail:
| | - Kareena Rajani
- Department of Clinical Research, OAKS Clinic, Mumbai, Maharashtra, India
| | - Urvil A Shah
- Department of Orthopaedic, OAKS Clinic, Mumbai, Maharashtra, India
| | - Anmol RS Mittal
- Department of Orthopaedic, OAKS Clinic, Mumbai, Maharashtra, India
| | - Rahul Sheth
- Department of Radiology, OAKS Clinic, Mumbai, Maharashtra, India
| | - Meenakshi Punamiya
- Department of Physiotherapy, MPth, OAKS Clinic, Mumbai, Maharashtra, India
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Affiliation(s)
- V Sivakumar
- Meenakshi Medical College and Research Institute, Kancheepuram, Tamilnadu, India and Gemini Scans, Aminjikarai, Chennai 600 029, Tamilnadu, India
- V. Indiran, Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai 600044, Tamilnadu, India
- IVR Scans, 1, Nellipet Cross Street, Chromepet, Chennai 600044, Tamilnadu, India
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Pawar P, Solomon J, John B, Luther A. Peroneal nerve palsy due to pseudoaneurysm following total knee arthroplasty: A case presentation. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wanken ZJ, Barnes JA, Eppolito AJ, Zwolak RM, Suckow BD. Coil embolization of an aberrant posterior tibial artery pseudoaneurysm after total knee arthroplasty. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:497-500. [PMID: 31763507 PMCID: PMC6859296 DOI: 10.1016/j.jvscit.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Zachary J Wanken
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - J Aaron Barnes
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Anna J Eppolito
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Robert M Zwolak
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Oversier LMR, Corten BJGA, Barten DG, Elshof JWM. Pseudoaneurysm of the superior lateral genicular artery following anterior cruciate ligament repair. Acta Chir Belg 2018; 118:258-263. [PMID: 28946810 DOI: 10.1080/00015458.2017.1371491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- L. M. R. Oversier
- Emergency Department, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - D. G. Barten
- Emergency Department, VieCuri Medical Centre, Venlo, The Netherlands
| | - J. W. M. Elshof
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
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Ghaffari S, Farsavian H, Daneshpoor SMM, Shayesteh M. Pseudoaneurysm of the Posterior Tibial Artery following Removal of Tibial Plate- A Rare Case. J Orthop Case Rep 2017; 6:46-49. [PMID: 28116268 PMCID: PMC5245937 DOI: 10.13107/jocr.2250-0685.500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Salman Ghaffari
- Department of Orthopaedics, Orthopaedic Research Center, Mazandaran University of Medical Science, Sari, Iran
| | - Hossein Farsavian
- Department of Orthopaedics, Orthopaedic Research Center, Mazandaran University of Medical Science, Sari, Iran
| | | | - Masoud Shayesteh
- Department of Orthopaedics, Orthopaedic Research Center, Mazandaran University of Medical Science, Sari, Iran
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Carollo A, Gagliardo G, DeVito PM, Cicchillo M. Stent graft repair of anastomotic pseudoaneurysm of femoral-popliteal bypass graft following patch angioplasty. J Surg Case Rep 2016; 2016:rjw198. [PMID: 27994009 PMCID: PMC5165050 DOI: 10.1093/jscr/rjw198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Andrea Carollo
- Department of Surgery, Northside Medical Center, Youngstown, OH, USA
| | | | - Peter M DeVito
- Department of Surgery, Northside Medical Center, Youngstown, OH, USA
| | - Michael Cicchillo
- Department of Surgery, Northside Medical Center, Youngstown, OH, USA
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Lazarov M, Van der Bracht H, Victor J, Stuyts B. Missed diagnosis of false aneurysm of the superficial femoral artery after closed complex fracture of the distal femur. Orthop Traumatol Surg Res 2014; 100:695-7. [PMID: 25193621 DOI: 10.1016/j.otsr.2014.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 03/15/2014] [Accepted: 04/04/2014] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- M Lazarov
- University Hospital Ghent/Sint-Augustinus Wilrjk, Sint-Augustinus Ziekenhuis, Oosterveldlaan 24, 2610 Wilrijk Antwerpen, Belgium.
| | - H Van der Bracht
- University Hospital Ghent/Sint-Augustinus Wilrjk, Sint-Augustinus Ziekenhuis, Oosterveldlaan 24, 2610 Wilrijk Antwerpen, Belgium
| | - J Victor
- Orthopedic and Traumatology Department, Ghent University, Belgium
| | - B Stuyts
- University Hospital Ghent/Sint-Augustinus Wilrjk, Sint-Augustinus Ziekenhuis, Oosterveldlaan 24, 2610 Wilrijk Antwerpen, Belgium
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Choo HJ, Kim JH, Kim DG. Arterial pseudoaneurysm at the arthroscopic portal site as a complication after arthroscopic rotator cuff surgery: a case report. J Shoulder Elbow Surg 2013; 22:e15-9. [PMID: 24129053 DOI: 10.1016/j.jse.2013.07.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/16/2013] [Accepted: 07/28/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Hye-Jung Choo
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
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Affiliation(s)
- Anil K Jain
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India,Address for correspondence: Dr. Anil K Jain, Prof. of Orthopaedics, Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi 110 095, India. E-mail:
| | - Sudhir Kumar
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India
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