Unusual Pseudoaneurysm of the Dorsalis Pedis Artery after an Iatrogenic Injury

Pseudoaneurysm of the Dorsalis Pedis Artery Following Open Reduction Internal Fixation of a Second Metatarsal Fracture: A Case Study

Pseudoaneurysms are created by a traumatic or iatrogenic perforation of an artery, resulting in accumulation of blood between the two outermost layers of a blood vessel, the tunica media and tunica adventitia. Pedal artery pseudoaneurysms are an extremely uncommon complication of foot and ankle surgery; therefore, few cases have been reported in the literature. Early diagnosis is important to ensure timely treatment of this condition. Once clinical suspicion has been established, urgent referral to vascular surgery for prompt surgical evaluation is required to prevent potentially harmful sequalae. We present the case of a 70-year-old female who developed a pseudoaneurysm of the dorsalis pedis artery 33 days after undergoing open reduction internal fixation (ORIF) of a second metatarsal fracture. Her treatment included urgent referral to vascular surgery with subsequent surgical repair of the pseudoaneurysm via ligation of the medial dorsal branch of the dorsalis pedis artery. At 10-month follow-up, she denied any pain, sensory deficits, or functional disability and had returned to all preinjury activities with no recurrence of the pseudoaneurysm. Our case study demonstrates early diagnosis and successful treatment of a pseudoaneurysm of the dorsalis pedis artery that developed shorty after ORIF of a second metatarsal fracture.

Revascularization of a Crushed Foot and Ankle Mortis

Foot crush injury is a difficult problem both from the complexity of the injury pattern standpoint and also the significant clinical and socioeconomic burden that it represents to the patient. Scoring systems exist to predict limb salvage, but the accuracy and implementation of these are varied, and thus clinical judgment must always be employed when attempting limb salvage. This case report describes the first use of a reversed saphenous interposition graft repair of a transected dorsalis pedis in a patient after sustaining crush injuries to the distal lower extremity. The patient was able to undergo partial limb salvage with the use of revascularization and judicious fasciotomies.

Giant Dorsalis Pedis Pseudoaneurysm Following Cannulation for Arterial Line in a Patient with Systemic Lupus Erythematosus

Dorsalis pedis artery (DPA) aneurysms are very rare and fewer than 60 cases have been reported in the literature. Most affected patients present with false aneurysms after orthopedic surgery or trauma. Here we report an unusual case of a giant DPA pseudoaneurysm after cannulation for arterial line placement in a patient newly diagnosed with systemic lupus erythematosus (SLE). A diagnostic delay resulted in necrosis of the overlying skin. Excision of the pseudoaneurysm, ligation of the DPA, and debridement of the foot dorsum were performed, followed by a second flap coverage surgery. Although a DPA false aneurysm is rare after arterial line removal, it can cause the serious complications of skin necrosis, rupture and toe necrosis. Arterial puncture sites should be carefully monitored, especially in patients with SLE or other vasculitis.