J Korean Orthop Assoc.  2010 Jun;45(3):238-242. 10.4055/jkoa.2010.45.3.238.

Therapeutic Embolization for Pseudoaneurysm of the Anterior Tibial Artery after Tibial Nailing

• Cho SH
• Kim DH
• Jeong ST
• Park HB
• Hwang SC
• Shin TB
• Shin HS

• KMID: 2185525
• DOI: http://doi.org/10.4055/jkoa.2010.45.3.238

Abstract

Closed intramedullary nailing is a favorite surgical technique for tibial shaft fracture. After closed interlocking intramedullary nailing, proximal and distal locking screws are inserted for increasing rotational force and axial stability. Vascular complications associated with tibial nailing for fractures are very rare. Here, we described a case of a pseudoaneurysm of the anterior tibial artery after tibial nailing. We opted for minimally invasive treatment consisiting of thrombin injection and vascular plug insertion. Because pseudoaneurysm of the anterior tibial artery can induce severe complications, one should, when performing closed intramedullary nailing, make a quick diagnosis and start treatment right away.

Keyword

tibial fracture; pseudoaneurysm; interlocking intramedullary nailing; embolization

MeSH Terms

Aneurysm, False
Embolization, Therapeutic
Fracture Fixation, Intramedullary
Nails
Thrombin
Tibial Arteries
Tibial Fractures
Thrombin

Figure

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  Figure 1 A 66-year-old male had a traffic accident. Preoperative radiographs show segmental fractures of tibia and fibula. (A) Preoperative anteroposterior radiograph. (B) Preoperative lateral radiograph.

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  Figure 2 (A) Postoperative anteroposterior radiograph. (B) Postoperative lateral radiograph.

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  Figure 3 Doppler evaluation of the lower leg revealed a pseudoaneurysm (5×5 cm sized) in the right anterior tibial artery.

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  Figure 4 (A) Angiogram shows pseudoaneurysm (5×5 cm sized) in the right anterior tibial artery. (B) Angiogram shows complete obliteration of the pseudoaneurysm after sono-guided thrombin injection.

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  Figure 5 (A) Angiogram shows insertion of the vascular plug (AMPLAZER®, AGA Medical Corp., Golden Valley, MN, USA). (B) Angiogram shows complete obliteration of the pseudoaneurysm.

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