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Popliteal artery pseudoaneurysm following primary total knee arthroplasty.

Shin YS, Hwang YG, Savale AP, Han SB - Knee Surg Relat Res (2014)

Bottom Line: An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty.The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation.In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.

No MeSH data available.


Related in: MedlinePlus

Computed tomographic angiography of the right lower limb. A large pseudoaneurysm of the right popliteal artery. The popliteal artery was occluded distal to the pseudoaneurysm and was reconstituted at the tibioperoneal trunk. No significant stenosis was noted in both crural arteries with good distal runoff.
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Figure 2: Computed tomographic angiography of the right lower limb. A large pseudoaneurysm of the right popliteal artery. The popliteal artery was occluded distal to the pseudoaneurysm and was reconstituted at the tibioperoneal trunk. No significant stenosis was noted in both crural arteries with good distal runoff.

Mentions: A 61-year-old woman who underwent bilateral TKA at a different institution, presented to our emergency orthopedic department on the third postoperative day with right knee and calf swelling, intolerable pain in the right lower limb, and weakness of right ankle dorsiflexors. Based on her surgery records, it was determined that the procedure involved an anterior midline skin incision followed by medial subperiosteal release along the proximal tibia via a medial parapatellar approach and implantation of a cemented knee prosthesis without tourniquet control (Fig. 1). There were no records available on the thromboembolic prophylaxis employed during the surgery, and the procedure was uneventful. She had no previous history of arterial disease or cardiovascular risk factors and trauma. However, the patient experienced weakness of right ankle dorsiflexors in the immediate postoperative period, which was diagnosed as common peroneal nerve palsy. The overall condition of the patient and the status of the right lower limb were good. Moreover, postoperative limb pulsation was present. The patient was immediately transferred to our emergency department and opioid analgesics were administered intravenously for pain relief. A thorough examination of the patient revealed a stable medical status and maintenance of vital parameters. On auscultation, there were no signs of adventitious sounds such as crepitus or rhonchi. Local examination revealed swelling over the entire right lower limb with painful restriction of motion of the right knee. In addition, we also noted swelling over the popliteal region, which was non pulsatile and without any signs of auscultation bruit. The postoperative status of the wound was good with no fresh discharge. On distal neurovascular examination, the right lower limb was found to be warm, and the pulsation of both the dorsalis pedis artery and posterior tibial artery was found to be normal. Neurologically, the ankle dorsiflexors were found to have motor grade 1, and there was a sensory deficit noted in the common peroneal nerve distribution. Based on these findings, a provisional diagnosis of common peroneal nerve palsy was made and a foot drop splint was applied immediately. The patient was then admitted to a ward for further observation. During the course of treatment, the patient reported decreased pain in the right lower limb with the use of analgesics, but the swelling of the entire right lower limb remained. A duplex examination of the right lower limb was performed as deep vein thrombosis was suspected; however, no evidence of deep vein thrombosis was noted. A computed tomographic (CT) angiography revealed a large popliteal artery pseudoaneurysm arising from the popliteal artery just above the knee with a large defect in the arterial wall, explaining the neurological symptoms (Fig. 2). The patient was immediately referred to a vascular surgeon for intervention. The lesion was treated with placement of a covered endovascular stent graft. After obtaining ante grade percutaneous access across the lesion, a covered 8×30 mm wall graft was placed. This resulted in a satisfactory sealing of the pseudoaneurysm (Fig. 3).


Popliteal artery pseudoaneurysm following primary total knee arthroplasty.

Shin YS, Hwang YG, Savale AP, Han SB - Knee Surg Relat Res (2014)

Computed tomographic angiography of the right lower limb. A large pseudoaneurysm of the right popliteal artery. The popliteal artery was occluded distal to the pseudoaneurysm and was reconstituted at the tibioperoneal trunk. No significant stenosis was noted in both crural arteries with good distal runoff.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061406&req=5

Figure 2: Computed tomographic angiography of the right lower limb. A large pseudoaneurysm of the right popliteal artery. The popliteal artery was occluded distal to the pseudoaneurysm and was reconstituted at the tibioperoneal trunk. No significant stenosis was noted in both crural arteries with good distal runoff.
Mentions: A 61-year-old woman who underwent bilateral TKA at a different institution, presented to our emergency orthopedic department on the third postoperative day with right knee and calf swelling, intolerable pain in the right lower limb, and weakness of right ankle dorsiflexors. Based on her surgery records, it was determined that the procedure involved an anterior midline skin incision followed by medial subperiosteal release along the proximal tibia via a medial parapatellar approach and implantation of a cemented knee prosthesis without tourniquet control (Fig. 1). There were no records available on the thromboembolic prophylaxis employed during the surgery, and the procedure was uneventful. She had no previous history of arterial disease or cardiovascular risk factors and trauma. However, the patient experienced weakness of right ankle dorsiflexors in the immediate postoperative period, which was diagnosed as common peroneal nerve palsy. The overall condition of the patient and the status of the right lower limb were good. Moreover, postoperative limb pulsation was present. The patient was immediately transferred to our emergency department and opioid analgesics were administered intravenously for pain relief. A thorough examination of the patient revealed a stable medical status and maintenance of vital parameters. On auscultation, there were no signs of adventitious sounds such as crepitus or rhonchi. Local examination revealed swelling over the entire right lower limb with painful restriction of motion of the right knee. In addition, we also noted swelling over the popliteal region, which was non pulsatile and without any signs of auscultation bruit. The postoperative status of the wound was good with no fresh discharge. On distal neurovascular examination, the right lower limb was found to be warm, and the pulsation of both the dorsalis pedis artery and posterior tibial artery was found to be normal. Neurologically, the ankle dorsiflexors were found to have motor grade 1, and there was a sensory deficit noted in the common peroneal nerve distribution. Based on these findings, a provisional diagnosis of common peroneal nerve palsy was made and a foot drop splint was applied immediately. The patient was then admitted to a ward for further observation. During the course of treatment, the patient reported decreased pain in the right lower limb with the use of analgesics, but the swelling of the entire right lower limb remained. A duplex examination of the right lower limb was performed as deep vein thrombosis was suspected; however, no evidence of deep vein thrombosis was noted. A computed tomographic (CT) angiography revealed a large popliteal artery pseudoaneurysm arising from the popliteal artery just above the knee with a large defect in the arterial wall, explaining the neurological symptoms (Fig. 2). The patient was immediately referred to a vascular surgeon for intervention. The lesion was treated with placement of a covered endovascular stent graft. After obtaining ante grade percutaneous access across the lesion, a covered 8×30 mm wall graft was placed. This resulted in a satisfactory sealing of the pseudoaneurysm (Fig. 3).

Bottom Line: An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty.The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation.In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.

No MeSH data available.


Related in: MedlinePlus