Arteriovenous Fistula and Pseudoaneurysm of the Posterior Tibial Artery After Calcaneal Slide Osteotomy: A Case Report

Doty, Jesse F.; Alvarez, Richard G.; Asbury, Brandon S.; Rudd, Joseph N.; Baxter, William B.

doi:10.3113/fai.2010.0329

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…Like Doty et al and Greene et al, we suggest that calcaneal osteotomy should be completed through the medial calcaneal cortex in a carefully controlled manner because of the proximity of vascular structures. 9,15 In this study, the average closest point between line A and the LPA was 59.3% when expressed as a percentage of the total distance of line A from the posterosuperior aspect of the calcaneal tuberosity.…”

Section: Discussionmentioning

confidence: 57%

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Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Tonogai¹,

Sairyo²,

Tsuruo³

2020

Preprint

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Background Calcaneal osteotomy is used to correct hindfoot deformity. Pseudoaneurysms of the lateral plantar artery (LPA) have been reported following calcaneal osteotomy and are at risk of rupture. The vascular structures in close proximity to the calcaneal osteotomy have variable courses and branching patterns. However, there is little information on the “safe zone” during calcaneal osteotomy. This study aimed to identify the safe zone that avoids LPA injury during calcaneal osteotomy.Methods Enhanced computed tomography scans of 25 fresh cadaveric feet (13 male and 12 female specimens; mean age 79.0 years at time of death) were assessed. The specimens were injected with barium via the external iliac artery. A landmark line (line A) connecting the posterosuperior aspect of the calcaneal tuberosity and the origin of the plantar fascia was drawn and the shortest perpendicular distance between the LPA and line A was measured on sagittal images.Results The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 feet (8.0%), the perpendicular distance between the LPA and line A at its closest point was very short (approximately 9 mm). In 18 of the 25 feet (72.0%), the point where the perpendicular distance from line A to the LPA was closest was the bifurcation of one of the medial calcaneal branches of the LPA, and in 7 feet (28.0%) the shortest perpendicular distance from line A to the LPA was the trifurcation of the LPA, medial plantar artery, and one of the medial calcaneal branches.Conclusion Calcaneal osteotomy performed more than 9 mm from line A could damage the LPA by overpenetration on the medial side. Calcaneal osteotomy on the medial side should be performed with caution to avoid iatrogenic injury to the LPA.Level of Evidence: IV, cadaveric study

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Section: Discussionmentioning

confidence: 57%

“…8 One of the complications reported after calcaneal osteotomy is pseudoaneurysm of the LPA. 9,10 Progressive enlargement of an untreated LPA pseudoaneurysm can compromise adjacent nerves and vessels and lead to ulceration and ultimately rupture 11 if the laceration…”

Section: Introductionmentioning

confidence: 99%

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Tonogai¹,

Sairyo²,

Tsuruo³

2020

Preprint

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“…They concluded that completion of the osteotomy on the medial side should be performed with caution. Doty et al 2 published a case report which described an arteriovenous fistula and pseudoaneurysm after calcaneal slide osteotomy. Ptaszek et al 12 described the development of a lateral plantar artery pseudoaneurysm after calcaneal osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Before performing this osteotomy in clinical practice, it seemed wise to perform an anatomic study to evaluate the relation of the osteotomy with the medial neurovascular structures especially since there have been several case reports describing damage to neurovascular structures after calcaneal osteotomy. 2 …”

Section: Introductionmentioning

confidence: 99%

Relationship of the Scarf Valgus-Inducing Osteotomy of the Calcaneus to the Medial Neurovascular Structures

et al. 2011

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“…Se han reportado fístulas arteriovenosas y parálisis del nervio tibial. 87,88,89 Técnica quirúrgica: la incisión se inicia por debajo del maléolo lateral en un ángulo aproximado de 45 grados, evitando el nervio sural y sus ramas así como los tendones peroneos. La disección continúa hasta el hueso, los separadores de Hohmann se colocan en posición dorsal y plantar alrededor del hueso para proteger las estructuras y los tejidos blandos.…”

Section: Osteotomía Medializante De Koutsogiannisunclassified

Pie plano adquirido del adulto por disfunción del tibial posterior. Opciones para el tratamiento quirúrgico

Núñez-Samper¹,

Llanos-Alcázar²,

Viladot-Pericé³

et al. 2021

Acta Ortopédica Mexicana

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RESUMEN.Presentamos la posible causa etiopatogénica de la disfunción del tibial posterior o pie plano doloroso del adulto y la relación causa-efecto que puede existir. También exponemos la clasificación de la lesión y las diferentes opciones para el tratamiento quirúrgico de la deformidad. Desde 1939, múltiples artículos han sido publicados, avalados por la clínica, así como por estudios experimentales, electromiográficos y biomecánicos; publicaciones consultadas y evaluadas para el desarrollo de esta revisión, según nuestro criterio: el primum movens de la disfunción del tibial posterior es ocasionado por un fallo del ligamento en hamaca o calcáneo navicular plantar (spring ligament), principal estabilizador pasivo del arco plantar interno. Este fallo supondría en el tiempo un aumento de trabajo del tendón tibial posterior, de por sí «insuficiente», que entraría en fatiga hasta llegar a la rotura parcial o total. Los trabajos publicados en relación con los procedimientos de partes blandas que actúan sobre el tendón tibial posterior en el estadio II no han tenido el resultado esperado en la historia natural de la deformidad. La artrodesis por el contrario, ha sido efectiva en otros estadios, pero está asociada a una pérdida de la dinámica del movimiento en el retropié y a un aumento de la presión en las articulaciones adyacentes.Palabras clave: Disfunción del tibial posterior, ligamento en hamaca, pie plano doloroso del adulto. ABSTRACT.We present the possible etiopatogenic causes of posterior tibial dysfunction or painful flat foot of the adult and the cause-and-effect relationship that may exist. We also expose the gradation of the lesion and the different therapeutic options for the surgical treatment of the deformity. Since 1939, multiple articles have been published, which have been endorsed by clinical, experimental, electromyographic and biomechanical studies; publications that have been consulted and evaluated for the development of this review. In our opinion: the dysfunction of the posterior tibial is caused in principle by a failure of the plantar navicular calcaneus ligament (spring ligament), the main passive stabilizer of the internal plantar arch. This failure would, in time, mean an increase in work of the posterior tibial tendon, in itself «insufficient», which would go into fatigue, until it reached a partial or total rupture. Published work on soft-part procedures acting on the posterior tibial tendon in stage II has not had the expected result in the natural history of deformity. Arthrodesis, on the other hand, has been effective in other stages, but is associated with a loss of movement dynamics in the back foot and increased pressure on adjacent joints.

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Arteriovenous Fistula and Pseudoaneurysm of the Posterior Tibial Artery After Calcaneal Slide Osteotomy: A Case Report

Abstract: For information on pricings and availability of reprints, call 410-494-4994, x232. Fig. 2: Magnetic resonance angiogram revealing an arteriovenous malfor mation with a pseudoaneurysm measuring 1.8 x 3 cm.

Cited by 6 publications

References 13 publications

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Relationship of the Scarf Valgus-Inducing Osteotomy of the Calcaneus to the Medial Neurovascular Structures

Pie plano adquirido del adulto por disfunción del tibial posterior. Opciones para el tratamiento quirúrgico

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