Elsevier

Injury

Volume 32, Issue 10, December 2001, Pages 771-778
Injury

Encounters with pseudoaneurysms in orthopaedic practice

https://doi.org/10.1016/S0020-1383(01)00094-8Get rights and content

Abstract

Thirteen pseudoaneurysms are presented of which five were caused as a complication of pin/wire placement of external fixators (one conventional and four Ilizarov frames). The most common symptom was the presence of profuse persistent bleeding from either the wound or the pin/wire site. In nine patients the pseudoaneurysm was directly caused by a fracture or subsequent fracture stabilisation. Pre-operative evaluation included radiography, arteriography, Doppler and computed tomography (CT) angiography. Depending on the site and size of the pseudoaneurysm management consisted of either ligation, resection and end-to-end anastamosis/vein grafting, lateral suture, endoaneurysmorrhaphy or selective embolisation.

A high index of suspicion needs to be maintained following penetrating injury in the vicinity of a major vessel, particularly in the presence of persisting symptoms. External fixators are widely used to treat complex orthopaedic problems. The procedure is technically demanding, requiring a sound knowledge of cross-sectional limb anatomy. Injudicious use may result in potentially life/limb threatening complication of pseudoaneurysm.

Introduction

Pseudoaneurysms are associated with penetrating injuries resulting from a tangential laceration through all the three layers of the wall of an artery. In civilian practice stab wounds, industrial accidents and road traffic accidents with/without associated fractures are the usual causes.

With the use of external fixators there is an inherent risk of pseudoaneurysm caused by the insertion of pins/wires, and the added trauma of distraction.

We report our experience in treating 13 cases of false aneurysm of which a significant number were caused as a result of external fixation performed on the extremities.

Section snippets

Material and methods

Thirteen patients with suspected post-traumatic peripheral pseudoaneurysms were admitted to the department of Orthopaedic surgery between 1991 and 1999. Clinical suspicion was based on the presence of,

  • 1.

    profuse persistent bleeding from either the wound or pin site;

  • 2.

    progressive pulsatile swelling.

A detailed history and physical examination was recorded for each patient at the time of admission to determine,

  • 1.

    the mode of injury;

  • 2.

    site of injury;

  • 3.

    associated injuries and/or complications;

  • 4.

    previous operative

Observations and results

Thirteen patients with traumatic pseudoaneurysms of the peripheral vascular system were treated in the department of Orthopaedic Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital in an 8-year period (1991–1999; Table 1). All were male patients with an average age of 27.8 years (range 12–52 years).

The commonest vessel to be involved was the deep femoral artery (five cases) while the internal iliac, profunda femoris, common femoral, popliteal, posterior tibial, peroneal,

Discussion

Traumatic pseudoaneurysms follow incomplete disruption of an artery and result in leakage of blood into the surrounding tissues. The uninjured portion of the arterial wall prevents the vessel from contracting leading to unbridled extravasation, which in due course organises and develops a fibrous capsule [1]. However, turbulent blood flow continues in the central region (Fig. 5). The classical presentation is that of an enlarging pulsatile swelling. A systolic bruit may be audible and a thrill

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