Spontaneous pseudoaneurysm of the posterior tibial artery successfully treated by open surgery

Abstract

Rationale: An extremely rare spontaneous pseudoaneurysm (PSA) of the posterior tibial artery (PTA) in a middle-aged male patient was cured by open surgery effectively. Patient concerns: A 53-year-old man presented with the increasing swollen left shank for 1 day, with intermittent pain, pulselessness and pallor. He denied the history of trauma, infection, and other diseases. Diagnoses: Physical examination, past medical history, ankle brachial index, ultrasonography, computed tomographic angiography (CTA), 3-dimensional reconstruction image of the popliteal artery and its branches and histological examination of intraluminal thrombus and clots helped us diagnose the patient as spontaneous PSA of PTA. Interventions: Our patient underwent excision of PSA and repair operation of PSA. Outcomes: The patient recovered well at 2-year follow-up. Lessons: This rare case provides valuable insights for tissue repair and vascular surgery. Therapeutic methods should be in accordance with the best interest of patient. Open surgery is the effective treatment for spontaneous PSA of PTA.

True Aneurysm on Posterior Tibial Artery as Late Complication of SARS-CoV-2

“…Degenerative changes lesions secondary to mycotic infection, polyarteritis nodosa are also described as responsible for true aneurysm. In our patient, we could not find any etiological factor, such as trauma, atherosclerosis or connective disorders 2 , 5 The only recent inflammatory event in our patient was the SARS-CoV-2 infection.…”

“…Although ligation of posterior tibial artery may be performed, especially in emergency settings, surgical excision with posterior tibial artery reconstitution either by primary repair or by interposition vein graft is the preferred treatment. Endovascular embolization and percutaneous occlusion of aneurysm with various modalities are more commonly used in pseudo-aneurysms and are associated with risk of limb ischemia 2 , 5 …”

Pseudoaneurysm in posterior tibial artery: A rare complication in fracture tibia fibula treated with fasciotomy and external fixator

“…Management options for traumatic pseudoaneurysm are open surgeries [4] involves achieving proximal and distal vascular control, followed by evacuating hematoma, arterial wall defect repair by primary closure or secondarily venous patch graft, endovascular coil [6] embolization can be perform before rupture. Other options includes ultrasound guided occlusion with thrombin injection.…”