Pseudoaneurysm of the Anterior Tibial Artery following Tibio-Talar-Calcaneum Fusion with a Retrograde Nail: A Rare Case and Literature Review

Abstract

This study reports the case of an 87-year-old woman who presented with a nonresolving haematoma 13 weeks following tibiotalar arthrodesis surgery on her right ankle using a retrograde nail. This was revealed by angiography to be a pseudoaneurysm of the anterior tibial artery. The patient subsequently underwent endovascular stenting of the pseudoaneurysm and has had a successful recovery. This case highlights the need for awareness of both the normal arterial supply to the leg and ankle as well as the potential for anatomical variations. Arterial variation may be as high as 6.7% based on published findings from cadaveric studies. As pseudoaneurysm is a rare complication, a high index of suspicion is needed in order to avoid a missed or delayed diagnosis. We urge surgeons to keep in mind the potential for pseudoaneurysm when a patient presents with a nonresolving haematoma and arrange appropriate further investigations as needed.

A tibioperoneal trunk mycotic pseudoaneurysm successfully treated with ligation

“…These are most commonly secondary to trauma 10,11 or an orthopedic procedure. [12][13][14][15][16] The incidence of distal PSA is increasing with the increasing rate of transpedal and distal access for interventional and diagnostic procedures. 17 In conclusion, although these cases are rare with modern antibiotics, a vascular surgeon must keep this diagnosis on the differential.…”

“…These are most commonly secondary to trauma 10 , 11 or an orthopedic procedure. 12 , 13 , 14 , 15 , 16 The incidence of distal PSA is increasing with the increasing rate of transpedal and distal access for interventional and diagnostic procedures. 17 …”

Traumatic pseudoaneurysm following ankle trauma

“…As reported above, there are several options for treatment by either surgical or radiological intervention. A less invasive treatment option not mentioned yet is coil embolization or endovascular covered stent placement, as described by Craxford et al 2 and Sadat et al 4 …”

The Case of a Job Well Done?

“…Vascular complications after treatment of tibial shaft fractures in general are quite rare, and comprise of direct arterial/venous damage, compartment syndrome and deep vein thrombosis (DVT) [2]. Most of the direct arterial injuries reported in the literature are sporadic case reports following external fixator or Ilizarov instrumentation placement [3,4], but also after intramedullary nailing of the Tibia [5] and even after arthroscopic treatment of ankle injury [6].…”