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Pseudoaneurysm after high tibial osteotomy and limb lengthening
J F Griffith1, J C Cheng, T K Lung
1Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Clinical Orthopaedics and Related Research
|October 2, 1998
Summary
Limb lengthening surgery can lead to anterior tibial artery rupture and pseudoaneurysm formation, especially in scarred limbs. Early recognition and transarterial embolization are key to successful treatment of this rare complication.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Trauma Surgery
Background:
- Limb length discrepancy due to prior fractures necessitates complex reconstructive surgery.
- Distal femoral and proximal tibial osteotomies combined with limb lengthening were performed to correct deformity.
- The patient had a history of two corrective surgeries for leg length discrepancy.
Observation:
- A young male patient developed oozing from a surgical scar during limb distraction 26 days post-operation.
- Anterior tibial artery rupture and pseudoaneurysm became apparent 70 days after surgery.
- Initial postoperative foot pulses were normal, suggesting a late-onset vascular complication.
Findings:
- Limb lengthening surgery precipitated anterior tibial artery rupture and pseudoaneurysm formation.
- The complication likely resulted from aggravation of an unrecognized arterial injury or de novo rupture in a scarred artery.
- Transarterial embolization provided successful treatment for the pseudoaneurysm.
Implications:
- This case highlights a rare but serious vascular complication associated with limb lengthening in scarred limbs.
- Vigilance for vascular compromise is crucial during and after limb lengthening procedures.
- Successful management involved prompt diagnosis and endovascular intervention.