J Korean Orthop Assoc.  2015 Oct;50(5):418-423. 10.4055/jkoa.2015.50.5.418.

Delayed Onset of the Popliteal Artery Pseudoaneurysm Following Medial Opening Wedge High Tibial Osteotomy

• Lim HS
• Kim SM
• Kim CK

• KMID: 2185106
• DOI: http://doi.org/10.4055/jkoa.2015.50.5.418

Abstract

High tibial osteotomy is an established method in treatment of medial knee osteoarthritis with varus deformity in younger patients. The popliteal artery is vulnerable to injury during surgeries performed around the knee joint. Pseudoaneurysm of the popliteal artery following medial opening wedge high tibial osteotomy is rare. A femoral angiogram revealed a pseudoaneurysm arising from the popliteal artery near the osteotomy site. Careful placement of retractors around the osteotomy site during sawing and flexing the knee to displace the popliteal artery away are recommended to prevent this complication. We report on the case of a pseudoaneurysm of the popliteal artery complicating medial opening wedge high tibial osteotomy that was treated clinically and radio-graphically with literature reviews.

Keyword

popliteal artery; pseudoaneurysm; genu varum; angiography; osteotomy

MeSH Terms

Aneurysm, False*
Angiography
Congenital Abnormalities
Genu Varum
Humans
Knee
Knee Joint
Osteoarthritis, Knee
Osteotomy*
Popliteal Artery*

Figure

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  Figure 1 Preoperative magnetic resonance imaging. (A) A longitudinal horizontal tear is present from body to posterior horn. (B) A radial tear is present at the posterior horn of the lateral meniscus.

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  Figure 2 Pre- and postoperative scenography. (A) The femorotibial angle measured 8° on the right and 5.8° on the left of anatomical varus. (B) Postoperative standing radiographs showing satisfactory correction of the varus deformity.

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  Figure 3 Preoperative radiographs of both knees. The Rosenberg view of both knees shows mild gonarthrosis of both knees. PA, posterioranterior.

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  Figure 4 Postoperative radiographs of both knees. Preoperative varus gonarthrosis is well corrected by open wedge high tibial osteotomy fixed with an anatomical plate.

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  Figure 5 Lower extremity nonenhanced computed tomography. Approximately 6-cm-sized, ill-defined round isodense mass like lesion at the soleus muscle area of the proximal tibia level.

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  Figure 6 (A) Femoral angiography study showing a pseudoaneurysm (11.5×8.5-cm-sized) from the popliteal artery with the neck just near the lateral end of the osteotomy site. (B, C) Femoral angiography shows complete obliteration of the pseudoaneurysm after placing a stent in the popliteal artery.

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  Figure 7 Lower extremity angio-computed tomography (CT). One month after stent implantation. Follow-up CT image demonstrates improvement of pseudoaneurysm.

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  Figure 8 Intraoperative C-arm fluoroscopy. Radiolucent hohmann retractor protects the popliteal artery.

Reference

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