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Case Reports
. 2017 Mar;46(3):275-279.
doi: 10.1007/s00132-016-3373-3.

Pseudoaneurysm of a high-division anterior tibial artery following primary TKA

Ran Zhao  1 , Yang Li  1 , Yanqing Liu  2   3 , Ke Zhang  1 , Zhongjun Liu  1
Affiliations
Case Reports

Pseudoaneurysm of a high-division anterior tibial artery following primary TKA

Ran Zhao et al. Orthopade. 2017 Mar.

Abstract
in English, German

Arterial complications following total knee arthroplasty are rare but carry a high risk of significant morbidity and mortality. Herein, the authors report a case of pseudoaneurysm in a branch of a high-division anterior tibial artery caused by laceration by the retractor following primary total knee arthroplasty in a 72-year-old woman. The patient presented with an unexplained hematoma and an enlarging swelling, with pallor and acute hemorrhage on the first postoperative day. The diagnosis was confirmed by arteriography and the patient was successfully treated using endovascular embolization without long-term complications. Because of the high risk of progression to a potentially limb- or life-threatening condition, it is important to discuss the risk factors for this complication, as well as its early diagnosis and treatment methods.

Arterielle Komplikationen nach totaler Kniearthroplastik sind selten, weisen aber eine hohes Risiko erheblicher Morbidität und Mortalität auf. In der vorliegenden Arbeit berichten die Autoren über den Fall eines Pseudoaneurysmas, das einen hoch abgehenden Ast der A. tibialis anterior betraf und durch einen vom Retraktor verursachten Geweberiss nach primärer totaler Kniearthroplastik bei einer 72-jährigen Patientin entstand. Die Patientin wies am ersten postoperativen Tag ein Hämatom unklarer Genese und eine zunehmende Schwellung mit Blässe und akuter Hämorrhagie auf. Mittels Arteriographie wurde die Diagnose bestätigt und die Patientin erfolgreich durch eine endovaskuläre Embolisation ohne Langzeitkomplikationen behandelt. Wegen des hohen Risikos der Progression zu einer potenziell für die Extremität oder das Leben bedrohlichen Situation ist es wichtig, die Risikofaktoren dieser Komplikation zu erörtern sowie Verfahren zur frühzeitigen Diagnosestellung und Behandlung darzustellen.

Electronic supplementary material: The online version of this article (doi: 10.1007/s00132-016-3373-3) contains two videos on diagnosis and treatment of the pseudoaneurysm. The article and the supplementary material are available in the electronic archive at http://www.springermedizin.de/der-orthopaede.

Keywords: Anterior tibial artery; Embolism; Hematoma; Risk factors; Thrombosis.

PubMed Disclaimer

Conflict of interest statement

R. Zhao,Y. Li,Y. Liu, K. Zhang, and Z. Liu declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
a An unexplained hematoma and an enlarging swelling developed on the left knee on the first postoperative day. b Urgent angiography showed a pseudoaneurysm arising from a branch of the anterior tibial artery, which is a high division of the popliteal artery above the knee joint. c, d The pseudoaneurysm was treated with microcoil embolization
Fig. 2
Fig. 2
a A suspected high-division anterior tibial artery (ATA) moved up the branch vessel position. The mechanism of vascular injury was laceration of a branch of the high-division ATA along the subperiosteum by the point of the retractor during retraction of the lateral soft tissue, as shown in (b). This may have occurred if the retractor was inserted too deeply or at an incorrect angle
See this image and copyright information in PMC

References

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