No abstract

Objectives: Infrapopliteal arterial pseudoaneurysms (IAP) following blunt trauma with associated orthopedic injuries are uncommon, often present in a delayed fashion, and encompass a diagnostic and therapeutic dilemma. Herein, we present a series of IAPs that were diagnosed following blunt trauma and their management. Methods: Case series consisting of 3 patients and a review of the international literature. Results: Our case series included 3 patients presenting with IAPs following blunt trauma with associated orthopedic injuries. They were all identified in a delayed manner (>3 weeks) after the orthopedic injuries were treated. All patients presented with pain and a pulsatile mass while one concurrently had neurologic deficits. The pseudoaneurysms were diagnosed by duplex ultrasound and confirmed by angiography to be originating from the tibioperoneal trunk, anterior tibial, and posterior tibial arteries respectively. Two patients were treated with surgical excision. Of these, one required an arterial bypass procedure while the other underwent direct ligation only. The third patient was treated by endovascular coiling. A literature review from 1950 to the present found 51 reported cases of IAP resulting from blunt trauma. Ninety percent of trauma-related infrapopliteal injuries occurred in men with a mean delay in diagnosis of 5.6 months (median 1.8 months) after injury. Since 1950, management has shifted from primarily ligation to incorporating minimally invasive endovascular techniques when appropriate. Conclusions: Infrapopliteal artery pseudoaneurysms are rare following blunt skeletal trauma. A delay in diagnosis often occurs and can result in major morbidity and extensive surgical intervention. We recommend a high index of suspicion and a thorough vascular examination in patients with lower extremity skeletal trauma to help identify and treat these injuries early and effectively.

in 68% (34/50) of patients, with respiratory failure being the most common (n ¼ 20 [40%]). No patient experienced stroke or upper extremity ischemia. There were 14 (28%) vascular complications, which included 2 (4%) early aorta-related reinterventions secondary to device compression; these devices were implanted outside the instructions for use. The mean follow-up was 52.4 months (range, 1 month-14.9 years). During the late follow-up period, there were two device-related complications, both repaired with Palmaz stenting. One patient required an axillofemoral bypass for device compression and subsequent Palmaz stenting at 5.5 months. In the other case, the patient originally had an attempt at open repair at another institution. The aorta was wrapped with felt to prevent bleeding, and the patient was transferred for TEVAR. The stenosis occurred in the region of the wrapping at 4 years and was treated with a Palmaz stent. Two patients died (at 8.5 and 43 months, respectively) of non-aorta-related causes (Fig). There were no endoleaks or device fracture or migration.Conclusions: Assessment of long-term outcomes demonstrated few device-related complications that were associated with early off-label device use. Therefore, it may be reasonable to decrease routine surveillance after device implantation, especially in young patients who are at increased risk from radiation exposure. Larger studies with current device iterations will be helpful in determining the optimal surveillance protocol.Objective: Infrapopliteal artery pseudoaneurysms (IAP) after orthopedic injuries are uncommon and often are manifested in a delayed fashion. Herein, we present a series of IAPs that were diagnosed after blunt orthopedic trauma and their management.Methods: This is a case series consisting of three patients and a systematic review of the international literature.Results: Our case series included three patients presenting with IAPs after blunt trauma with associated orthopedic injuries. They were identified in a delayed manner (>3 weeks) after the orthopedic injuries had been treated. All patients presented with pain and a pulsatile mass; one concurrently had neurologic deficits. Interestingly, all the pseudoaneurysms were large (4.5-10 cm), providing an important reason for suspecting this uncommon complication. All pseudoaneurysms were diagnosed by duplex ultrasound (Fig). Each of the three IAPs were confirmed by angiography and originated from the tibioperoneal trunk and anterior tibial and posterior tibial arteries. Two patients were treated with surgical excision. Of these two patients, one required bypass surgery, whereas the other underwent direct ligation only. The third patient was treated by endovascular coiling to exclude the pseudoaneurysm. After each repair, the affected limbs were free of ischemia. All patients recovered uneventfully and were doing well at follow-up. A review of the literature from 1956 to the present indicated 51 reported cases of IAPs resulting from blunt trauma. Ninety percent of trauma-related infrapop...