Therapeutic Embolization for Pseudoaneurysm of the Anterior Tibial Artery after Tibial Nailing

Se-Hyun Cho; Dong-Hee Kim; Soon-Taek Jeong; Hyung-Bin Park; Sun-Chul Hwang; Tae-Beom Shin; Hyuck-Soo Shin

doi:10.4055/jkoa.2010.45.3.238

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Cho, Kim, Jeong, Park, Hwang, Shin, and Shin: Therapeutic Embolization for Pseudoaneurysm of the Anterior Tibial Artery after Tibial Nailing

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(3): 238-242.

Published online: 9 June 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.3.238

Therapeutic Embolization for Pseudoaneurysm of the Anterior Tibial Artery after Tibial Nailing

Se-Hyun Cho, M.D., Dong-Hee Kim, M.D., Soon-Taek Jeong, M.D., Hyung-Bin Park, M.D., Sun-Chul Hwang, M.D., Tae-Beom Shin, M.D.^*, Hyuck-Soo Shin, M.D.

Department of Orthopedic Surgery, Research Institute of Clinical Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.

^*Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea.

Correspondence to: Dong-Hee Kim, M.D. Department of Orthopedic Surgery, Research Institue of Clinical Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, 90, Chilam-dong, Jinju 660-702, Korea. TEL: +82-55-750-8870, FAX: +82-55-754-0477,dhkim8311@yahoo.co.kr

Received 2 December 2009 Accepted 18 April 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Closed intramedullary nailing is a favorite surgical technique for tibial shaft fracture. After closed interlocking intramedullary nailing, proximal and distal locking screws are inserted for increasing rotational force and axial stability. Vascular complications associated with tibial nailing for fractures are very rare. Here, we described a case of a pseudoaneurysm of the anterior tibial artery after tibial nailing. We opted for minimally invasive treatment consisiting of thrombin injection and vascular plug insertion. Because pseudoaneurysm of the anterior tibial artery can induce severe complications, one should, when performing closed intramedullary nailing, make a quick diagnosis and start treatment right away.

Keywords: tibial fracture, pseudoaneurysm, interlocking intramedullary nailing, embolization

Figures and Tables

Figure 1

A 66-year-old male had a traffic accident. Preoperative radiographs show segmental fractures of tibia and fibula. (A) Preoperative anteroposterior radiograph. (B) Preoperative lateral radiograph.

Figure 2

(A) Postoperative anteroposterior radiograph. (B) Postoperative lateral radiograph.

Figure 3

Doppler evaluation of the lower leg revealed a pseudoaneurysm (5×5 cm sized) in the right anterior tibial artery.

Figure 4

(A) Angiogram shows pseudoaneurysm (5×5 cm sized) in the right anterior tibial artery. (B) Angiogram shows complete obliteration of the pseudoaneurysm after sono-guided thrombin injection.

Figure 5

(A) Angiogram shows insertion of the vascular plug (AMPLAZER®, AGA Medical Corp., Golden Valley, MN, USA). (B) Angiogram shows complete obliteration of the pseudoaneurysm.

References

1. Gantz ED, Sweet MB, Jakim I. False aneurysm mimicking an aggressive soft-tissue tumor. A case report. J Bone Joint Surg Am. 1988. 70:1090–1092.

2. Crellin RQ, Tsapogas MJ. Traumatic aneurysm of the anterior tibial artery. A case report. J Bone Joint Surg Br. 1963. 45:142–144.

3. Vincent GM, Stanish WD. False aneurysm after arthroscopic meniscectomy. A report of two cases. J Bone Joint Surg Am. 1990. 72:770–772.

4. Ha YC, An SH, Park HB, Hwang SC. Therapeutic embolization for pseudoaneurysm of the lateral inferior genicular artery after total knee arthroplasty. A case report. J Korean Orthop Assoc. 2007. 42:556–558.

5. Sawant MR, Ireland J. Pseudo-aneurysm of the anterior tibial artery complicating high tibial osteotomy. A case report. Knee. 2001. 8:247–248.

6. Paul MA, Patka P, van Heuzen EP, Koomen AR, Rauwerda J. Vascular injury from external fixator. case reports. J Trauma. 1992. 33:917–920.

7. Kang SS, Labropoulos N, Mansour MA. Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms. J Vasc Surg. 2000. 31:289–298.

8. Cil B, Peynircioğlu B, Canyiğit M, Geyik S, Ciftçi T. Peripheral vascular applications of the Amplatzer vascular plug. Diagn Interv Radiol. 2008. 14:35–39.

9. Inamdar D, Alagappan M, Shyam L, Devadoss S, Devadoss A. Pseudoaneurysm of anterior tibial artery following tibial nailing: a case report. J Orthop Surg. 2005. 13:186–189.

10. Ebraheim NA, Lu J, Hao Y, Biyani A, Yeasting RA. Anterior tibial artery and its actual projection on the lateral aspect of the tibia: a cadaveric study. Surg Radiol Anat. 1998. 20:259–262.

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