Coil embolization of an aberrant posterior tibial artery pseudoaneurysm after total knee arthroplasty

Abstract

Arterial injury is a recognized but rare complication of total knee arthroplasty. These injuries, however, can be exceptionally devastating and potentially result in limb loss. Presentation may be delayed with symptoms associated with mass effect rather than with ischemia. We describe treatment of a patient with presentation delayed 2 weeks. In addition, the patient's arterial branch pattern demonstrated aberrant anatomy with high takeoff of the posterior tibial artery. This patient was successfully treated with transcatheter coil embolization. The current treatment options and published literature are reviewed.

Keywords: Coil embolization; Iatrogenic injury; Pseudoaneurysm.

Fig 1

Duplex ultrasound examination was performed to evaluate for venous thrombosis. A pseudoaneurysm of 3.7 cm in diameter was noted in the popliteal fossa as an incidental finding.

Fig 2

Anteroposterior arteriogram of the right knee area showing the pseudoaneurysm (PSA) behind the knee prosthesis.

Fig 3

Lateral arteriogram demonstrating the high branch point of the posterior tibial (PT) artery and origin of the pseudoaneurysm (PSA).

Fig 4

Completion arteriogram demonstrates complete exclusion of pseudoaneurysm after coil placement with preservation of robust anterior tibial (AT) and peroneal runoff.