Description
Objectives
Early diagnosis and treatment of iatrogenic pseudoaneurysm rupture, dependent on the popliteal artery or collateral branches, as an early complication of total knee arthroplasty.
Methods
A 73-year-old woman, who underwent a total knee replacement 5 days ago, went to the emergency room due to disproportionate pain in her left leg. On examination: swollen leg, posterolateral hematoma, pain on palpation of the popliteal fossa, gastrocnemius and sole of the foot, paresthesias and plantar sensory-motor deficit and posterior tibial pulse present. An ultrasound-doppler study was requested, which was completed with computed tomography angiography: pseudoaneurysm dependent on the collateral branch of the left popliteal artery. The patient underwent urgent surgery in two stages. First, endovascular exclusion of the pseudoaneurysm by placing an expandable balloon stent in the proximal portion of the posterior tibial artery. Secondly, fasciotomies of the superficial and deep posterior compartments, and the anterior and lateral compartments of the leg due to secondary compartment syndrome.
Results
After 9 days on the hospital ward, the wounds progress favorably and the patient begins to walk with persistence of plantar paresthesias. At 6 months of follow-up, the patient walks without assistance and without pain. Healed fasciotomy wounds. The range of motion of the knee is 0-100º, hip, ankle and toes free. Muscular balance 4+/5 in hip flexors; hip extensors, knee extensors and flexors 5/5; ankle and toe flexors 4+/5; 5/5 in ankle and finger extensors. Paraesthesia persists at the plantar level. Posterior tibial pulse present.
Conclusions
The rupture of the iatrogenic pseudoaneurysm dependent on the popliteal artery or one of its branches, in patients undergoing total knee arthroplasty, is an infrequent early complication, which can be associated with entities derived from acute bleeding, such as compartment syndrome. We must identify the warning signs and symptoms, such as disproportionate pain despite analgesia, significant swelling and hematoma, and sensory motor deficit, to carry out early diagnosis and treatment and thus avoid complications at a local and systemic level.
