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

Abstract

Profunda femoris artery (PFA) pseudoaneurysm after blunt trauma without associated femur fracture is a rare occurrence. Most of the reported cases of PFA pseudoaneurysm in the English literature developed after penetrating trauma, surgical procedures, and femur fractures. We present two such cases following blunt trauma and without any associated long bone injury. After initial imaging failed to show any long bone fracture, CT angiography confirmed pseudoaneurysm of the branch of the PFA. Both patients were then treated with emergent coil embolization of the bleeding vessel. Pseudoaneurysms typically present late and signs of persistent hip pain, thigh swelling, presence of a pulsatile mass, and even unexplained anemia all may suggest the diagnosis. Recognition of PFA pseudoaneurysm requires high index of suspicion and is often difficult to diagnose clinically because of its location.

Pseudoaneurysm of the proximal superficial femoral artery following blunt trauma in a footballer: A rare case report

“…Apart from these, there are other techniques where radiological intervention has successfully treated pseudoaneurysm. In the study done by Saptarishi et al, 1 they have treated the pseudoaneurysm by the endovascular coil embolization. However, they treated the case of pseudoaneurysm of deep femoral artery.…”

“…Pseudoaneurysm is a hematoma not contained by vessel walls, but rather contained by a thin fibrous capsule. 1 It is also known as false aneurysm. Pseudoaneurysm of superficial femoral artery without penetrating injury or femoral bone fracture is a rare clinical presentation.…”

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

“…They have been reported following various orthopaedic procedures including external fixation of femur, core decompression and internal fixation of the proximal femoral fractures 1. Pseudoaneurysms can result secondary to injury to PFA due to a spike of fractured bone, displaced implants, retractors, protruding cortical screw tip, gamma nail or overpenetration by a drill bit 2…”

“…Larger and symptomatic pseudoaneurysms may be treated with US-guided obliterative compression, direct US-guided thrombin injection, endovascular management using stent-graft placement or coil embolisation or open surgical repair 1. Recently, endovascular management is the preferred modality of treatment with surgery reserved for cases not amenable to embolisation 2. An important point of consideration is the well-developed collateral supply of the PFA which makes it necessary to embolise the feeding vessel both proximal and distal to the pseudoaneurysm to completely exclude it from the circulation by preventing backflow from the collateral circulation 1…”

The Effect of Blood Biochemistry and Hematological Parameters on the Development of Pseudoaneurysm

“…In the treatment of pseudoaneurysm, compression, thrombin or collagen injection, and coil embolization can be applied with USG. In addition, surgical stent or graft implantation and primary surgical repair can be performed (2,(7)(8)(9)(10).…”