Post-Thromboembolectomy Pseudoaneurysms Affecting Below-the-Knee Arteries and Their Management Strategies: A Literature Review

Abstract

Pseudoaneurysms resulting from Fogarty balloon catheterization for thromboembolism (termed post-thromboembolectomy pseudoaneurysms [PTPAs]) are rare but pose significant clinical challenges, particularly when they affect below-the-knee arteries. The underlying pathophysiology of PTPAs involves arterial wall injury, leading to blood extravasation and the formation of a pseudoaneurysm sac. The presentation of PTPAs varies but is often characterized by localized pain, swelling, and a palpable pulsatile mass, which may appear immediately or be delayed. Diagnostic modalities such as duplex ultrasound, computed tomography angiography, and digital subtraction angiography are essential for accurate detection and characterization. Management strategies for PTPAs range from conservative observation to radiological interventions and open surgical reconstruction. The choice of treatment depends on factors such as the size and anatomical location of the pseudoaneurysm, as well as the patient's overall health status. This review synthesizes case reports and highlights the critical importance of prompt diagnosis and individualized treatment strategies. Additionally, it underscores the need for ongoing research, particularly in complex cases requiring a combination of approaches, to refine treatment protocols and improve patient outcomes.

Keywords: Fogarty balloon catheter; below-the-knee arteries; endovascular intervention; pseudoaneurysm; surgical repair; thromboembolectomy; thromboembolism.

Figure 1

DSA images depict multiple PTPAs in BTK arteries of a 44-year-old man. These images were obtained by Edit Dósa (Heart and Vascular Center, Semmelweis University).

Figure 2

PRISMA flow chart of study selection.