Surgical management of peripheral artery pseudoaneurysm following orthopedic trauma: a report of 14 cases
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ORIGINAL ARTICLE
Surgical management of peripheral artery pseudoaneurysm following orthopedic trauma: a report of 14 cases A. Devendra1 · P. Gupta Nishith1 · P. Velmurugesan1 · Hari Venkatramani2 · J. Dheenadhayalan1 · S. Rajasekaran1 Received: 18 July 2020 / Accepted: 2 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Purpose of this study was to report the etiology, diagnosis, surgical management, and outcome of pseudoaneurysm associated with orthopedic trauma. Methods A retrospective review was conducted of all patients presenting to a Level 1 trauma center between 2013 and 2019. Clinical records were reviewed for the mechanism of primary injury, associated fracture pattern, time of presentation, site of involvement, etiology of the pseudoaneurysm, diagnosis, management, and complications. We identified 14 patients with pseudoaneurysm of peripheral arteries following orthopedic trauma. Results The mean interval between primary injury and the manifestation of clinical symptoms was 88.5 days (range, 16–304 days). There were 3 upper limb injuries and 11 lower limb injuries. The presenting symptoms were pain associated with excessive extremity swelling in most of the patients. A significant drop in hemoglobin (mean fall- 2.9 g/dL) was noted in nine patients. Most common artery involved was the superficial branch of femoral artery and posterior tibial artery followed by the brachial artery. Fractured bone spike was the cause of injury in eight patients and iatrogenic injury in six patients. Diagnosis was confirmed by CT angiography with duplex scan in eight patients, duplex scan alone in one patient, MRI along with duplex scan in one patient. The remaining four patients were diagnosed intraoperatively. Excision of the pseudoaneurysm and ligation of the involved minor arteries was done in eight patients. Surgical repair of the major artery with critical vascular injury was done in six patients. One patient underwent secondary amputation following the anastomotic blowout. Conclusion Early diagnosis of pseudoaneurysm requires knowledge and a high index of suspicion. Surgical reconstruction of major arteries should always be done and ligation of major vessels can lead to catastrophes. Excision of pseudoaneurysm can be done when minor arteries are involved with the presence of good collateral circulation. Level of Study Level IV Study. Keywords Pseudoaneurysm · Delayed vascular complication · Peripheral artery pseudoaneurysm · Iatrogenic injury · Fractured bone spike
Introduction A pseudoaneurysm is a pulsatile hematoma that communicates with an artery through a disruption in the arterial wall. Unlike a true aneurysm that is bounded by the arterial walls, a pseudoaneurysm is bounded by surrounding tissues * A. Devendra [email protected] 1
Department of Orthopaedics, Trauma and Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Tamil Nadu, 313, Mettupalayam Road, Coimbatore 641 043, India
Department of Plastic Surgery and Microsurgery, Ganga Medi
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