DEEP FEMORAL ARTERY PSEUDOANEURYSM AFTER ORTHOPEDIC PROCEDURE

  • Pedro Pinto Sousa Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
  • Clara Nogueira Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
  • Pedro Brandão Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
  • Alexandra Canedo Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
Keywords: Pseudoaneurysm, Deep Femoral Artery, Orthopedic Procedures, Endovascular, Coils Embolization

Abstract

Introduction: Most of the deep femoral artery (DFA) pseudoaneurysm (PSA) present asymptomatically or as a pulsatile mass. Clinical signs are variable and, normally, result from compression from adjacent structures but when ruptured it may present as haemorrhagic chock Symptomatic PSA should be treated. However, the decision to treat asymptomatic PSA is controversial. The majority of small PSA (less than 20–30 mm in diameter) are prone to spontaneous thrombose within 4 weeks, so literature recommends observing small, asymptomatic PSA and treating only if they enlarge, do not thrombose, or become symptomatic.

Materials and methods: The authors present two cases of PSA from a DFA branch after an orthopedic procedure.

Clinical case I – 83-year-old female admitted in the emergency department with left femoral shaft and lateral condyle trauma. Submitted to trochanteric osteosynthesis, complicated with deep vein thrombosis but no diagnosis of PSA by that time, so she was discharged with anti-coagulation. Re-admitted two months later with thigh pain and a diagnosis of DFA PSA. She was submitted to selective coil embolization with 2D Helical-35® of 3x52mm and one VortXTM Diamond® of 3x23mm.

Clinical Case II – 70-year-old female electively admitted for a total right hip replacement. Post procedure, she developed thigh hematoma, persistent hypotension and 2gr/dL haemoglobin decrease, not responsive to conservative measures. After diagnosed of a DFA PSA, she was submitted to selective embolization with two Tornado Cook® embolization coil of 2-5x50mm.

Discussion: Accurate diagnosis of DFA PSA is difficult, not only due to its rarity but also to a frequent delayed presentation. It has an incidence of 2% of all peripheral arterial wounds being more common after orthopaedic and vascular procedures. An endovascular approach has emerged as a minimum invasive technique that allows a precise localization and exclusion of the lesion identified. It has a successful rate near 100% when anatomically feasible.

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Published
2020-04-30
Section
Clinical Case