Management of a Case of Ruptured Pseudoaneurysm and Stenosis of Femoral Artery Caused by Femoral Osteochondroma

Abstract

A 21-year-old male patient presented with history of pain and paresthesia in right lower limb alongwith difficulty in walking. The patient was investigated and roentgenogram of right femur revealed presence of a bone tumor arising from posterior aspect as seen in lateral view [Table/ Fig-1].Magnetic resonance imaging (MRI) was also done and it revealed exostosis arising from femur with surrounding hematoma, without any evidence of infiltration into surrounding structures [Table/Fig2a,b].Computed tomography (CT) Angiogram although of valuable information was not done at this stage as the presence of a ruptured pseudoaneurysm was not suspected initially. Tumor was considered benign and surgical intervention in the form of excision of the tumor was planned. Spinal anesthesia was given and patient was turned in to prone position and a tourniquet was placed around upper thigh. Midline incision in the posterior aspect of lower part of right thigh was given and posterior thigh muscles were retracted to reach the tumor. Hematoma and clots were evacuated, injury to femoral artery was not suspected at that time, moreover presence of a hematoma had distorted the muscular planes and structure differentiation was difficult. Tumor was excised and sent for histopathology examination. There was no active bleeding, even after deflation of tourniquet, probably due to presence of a clot and or hypotension caused by anesthesia. After ensuring hemostasis and inserting a suction drain standard closure was done. The patient was well, without any complaints and there was minimal drainage therefore aBstRaCt We present a rare case of ruptured pseudoaneurysm of distal femoral artery due to osteochondroma in a 21-year-old male. The patient was initially treated for osteochondroma as ruptured pseudoaneurysm was not suspected. Diagnosis of ruptured pseudoaneurysm could only be made intraoperatively when rent in the femoral artery was found along with surrounding hematoma and obstruction in the distal femoral artery. Patient underwent multiple surgeries (resection of osteochondroma and femoro-popliteal bypass) and recovered well with palpable pulsations in the operated limb.drain was removed on second post-operative day. The patient again developed pain and swelling few days later at the operative site and was taken for re-exploration under combined epidural and spinal anesthesia. Re-exploration was done through the same incision and large hematoma along with clots were found, which were removed. After removal of the clots bleeding started from a rent in femoral artery (neck of pseudoaneurysm) it was at that time diagnosis of ruptured pseudoaneurysm was made. Proximal control on femoral artery stopped the bleeding and there was no back bleeding from the distal end. The distal segment of femoral artery/proximal popliteal artery was found completely obliterated with unhealthy vessel wall and surrounding tissues. Rent in the femoral artery was closed with polypropylene 6-0 sutures. As the soft tissues were unhealthy and there was inadequate norm...

Popliteal artery pseudoaneurysms in patients affected by osteochondroma

“…[10][11][12][13][14] Three cases of arterial rupture were described: two cases of male patients aged 21 years, who had popliteal pseudoaneurysms, 15,16 and one case of a distal superficial femoral artery pseudoaneurysm. 17 The venous system was involved in about 7% of cases, especially in the form of deep venous thrombosis by external compression. [18][19][20][21][22][23] Peripheral nerve compression with neurologic symptoms of paresthesia/dysesthesia or even motor impairment was also described in five cases.…”

“…10 - 14 Three cases of arterial rupture were described: two cases of male patients aged 21 years, who had popliteal pseudoaneurysms, 15 , 16 and one case of a distal superficial femoral artery pseudoaneurysm. 17 …”