Peroneal artery pseudoaneurysm after surgical stabilisation of a Weber C trimalleolar ankle fracture: A case report and review of literature

Abstract

A case of post-traumatic pseudoaneurysm of the peroneal artery is presented. This occurred after standard open reduction and internal fixation of a Weber type C trimalleolar fracture of the left ankle in a 33-year-old man. The pseudoaneurysm was diagnosed 12 weeks post-operatively when the patient attended the pre-assessment clinic for the removal of the syndesmosis screw. Diagnosis was confirmed on ultrasonography, and the anatomical site was confirmed by a digital subtraction angiogram. The pseudoaneurysm was coiled successfully, and the syndesmosis screw was removed in theatre the next day, without any post-operative complications. We explore the aetiology of post-traumatic peroneal pseudoaneurysms, with emphasis on the pathoanatomy and management as described in literature. This is a rare complication, but is easily manageable provided an index of suspicion is maintained.

Proximal peroneal artery traumatic pseudoaneurysm following a compound proximal tibial shaft fracture managed with an external fixator: A case report

“…No case reports were found in the literature of traumatic pseudoaneurysms of the lower limb as a complication arising from compartment syndrome or due to external fixator screw fixation and of proximal peroneal artery pseudoaneurysms. 1 Traumatic pseudoaneurysms may present either in the acute setting (in a majority, within a few weeks after the surgical intervention or trauma) or as a late sequalae (less common, presenting after many weeks to years). A high index of suspicion is needed by the clinicians when evaluating a patient presenting with bleeding from an external fixator pin site and a traumatic pseudoaneurysm should be excluded using angiography or colour Doppler ultrasound, as the presence of distal pulses does not preclude a pseudoaneurysm or other vascular complications.…”

“…Case reports on pseudoaneurysms of the peroneal artery, which are rare in the literature, are described in subjects between 17 years and 71 years, with a majority being less than 30 years 1 with ligament sprains, bimalleolar fractures and distal tibia/fibular fractures being the commonest associated injury.…”

“…No case reports of traumatic proximal peroneal pseudoaneurysms as a complication arising due to external fixator screw fixation or from proximal tibial fractures were found in the literature. 1 Treatment options described include both surgical (open repair and ligation) and interventional radiological interventions (ultrasound-guided thrombin injection and percutaneous endovascular repair with stents).…”

“…Post-traumatic pseudoaneurysms are localized haematoma with persistent communication with the native artery via a narrow neck 1 formed following direct arterial injury resulting in disruption of arterial wall continuity. Symptoms include leg swelling, bruising, pain, neurological signs due to nerve compression (commoner in femoral and popliteal aneurysms) and bleeding due to rupture, and their onset depends on the size, rate of expansion and its proximity to a nerve.…”

Traumatic Pseudoaneurysm of Peroneal Artery: A Case Report and Review of the Literature

“…The diagnosis was confirmed by ultrasonography, and the anatomical site of the lesion was demonstrated by a digital subtraction angiogram. The pseudoaneurysm was successfully coiled [11].…”