[An unusual cause of arterial vascular occlusion with peripheral embolism]

A 34-year-old man presented with a three week history of a bluish discolouration, tingling paraesthesia and severe intermittent pain of the right foot. Angiography showed occlusion of the right superficial femoral artery above the knee, as well as embolic occlusion of the distal lower limb. A fluoroscopic study demonstrated a tirefond perforating the femoral bone just on the level of the occlusion. Two osteosynthetic operations had been performed after a comminuted fracture seventeen and five months earlier, respectively. After the initial fibrinolytic therapy was without improvement over a period of 32 hours, the osteosynthetic screw was removed surgically. It was covered by callous tissue und protruded through the cortical layer more than 15 mm. After extraction of the screw and removal of thrombotic material the femoral artery was patent on control angiography.