Pseudoaneurysm of the profunda femoris artery following an inter-trochanteric fracture of the femur

Abstract

A 50-year-old gentleman was admitted under our services after a fall onto his right side. He sustained an inter-trochanteric fracture of his right femur with reverse obliquity pattern and a displaced fracture of the surgical neck of his right humerus. He had a history of alcohol abuse, but his past medical history was otherwise non-contributory. He underwent dynamic hip screw fixation of his right femur and Polarus nail insertion of his right humeral fracture. His post-operative stay was complicated by delerium tremens and a below knee DVT which required treatment with warfarin. Subsequent radiographs demonstrated stable medial displacement of the femoral shaft. Following stabilisation of his medical condition, he was discharged home on crutch walking.He was re-admitted seven months later with severe pain in his right groin radiating to the anterior aspect of his right thigh and weakness of his right leg. On examination, he was found to have a large nonexpansile pulsatile mass in his right groin. Arteriography was performed which confirmed the presence of a large pseudoaneurysm arising from the profunda femoris artery. He was also noted to have an ilio-femoral thrombosis and a Greenfield filter was therefore inserted. Attempted embolisation of his pseudoaneurysm failed. He then underwent surgical repair of his pseudoaneurysm.Post-operatively he was unable to straight leg raise and EMG studies demonstrated a severe femoral neuropathy. He was discharged form hospital on crutch walking (Figs. 1-3).

Pseudoaneurysm of the Profunda Femoris Artery following Blunt Trauma Treated by Endovascular Coil Embolization: Review of Two Cases and Relevant Literature

“…A pseudoaneurysm, also known as a false aneurysm, is a hematoma not contained by vessel walls but rather contained by a thin fibrous capsule [ 11 ]. The mass is usually pulsatile in nature, which can aid in diagnosis.…”

Profunda femoris pseudoaneurysm: An unusual and easily overlooked complication following injuries of the proximal femur

“…This patient developed sciatic nerve injury, a complication similar to femoral neuropathy previously described in the literature. 3 …”

Iatrogenic profunda femoris artery pseudoaneurysm: late presentation with successful endovascular microcoil embolisation

“…Although the approach to treatment is dictated by numerous factors, the size of the pseudoaneurysm remains the single most important determinant 3. Small (up to 2–3 cm) and asymptomatic pseudoaneurysms may be simply observed as they often thrombose spontaneously.…”