Post-traumatic posterior tibial artery pseudoaneurysm

Discussion:

Posterior tibial artery pseudoaneurysm is a recognized, though uncommon, late manifestation of vascular injury associated with tibial fractures. Pseudoaneurysms are more common with penetrating injuries, e.g. bullet injury, than with blunt trauma. Patients usually present late with complications, e.g. rupture, thrombosis, hemorrhage, compression of surrounding soft tissues.

The pathogenesis of pseudoaneurysm formation is attributed to the initial trauma caused by bone fragments or edges which may transect the arterial wall leading to local hematoma formation with subsequent degradation of the enclosed vessel.

Pseudoaneurysms are potentially limb-threatening complications of long bone fractures and a high index of suspicion is required for early diagnosis and repair. Presence of distal pulses can be misleading. Plain x-ray findings are unrelated to the possibility of vascular injury. Angiography, Doppler ultrasound and CT angiography can be useful in the management of pseudoaneurysms, both for diagnosis and treatment.

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