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Femoral Artery Pseudoaneurysm Caused by External Fixator

Dept. of Cardiovascular & Thoracic Surgery King Edward VII Memorial Hospital Parel Mumbai 400012, India

We recently treated a case of superficial femoral artery pseudoaneurysm resulting from external fixator pins. The patient was a 35-year-old general surgeon who sustained a grade-2 open fracture of the right femur. There was minimal loss of tissue on the anterior aspect of the thigh and no distal neurovascular deficit. The femur was stabilized with Hoffmann transfixation pins and a double-square frame. After 3 months, the patient noticed a pulsatile swelling on the anteromedial aspect of the right thigh, close to the external fixator pin. Angiography revealed a moderate-sized pseudoaneurysm of the right femoral artery arising from the anteromedial aspect, which was excised with end-to-end repair of the femoral artery.

Complications arising from external fixators, such as pin-track infection or transfixation of muscles, are well-known. Perforation, erosion, and occlusion of arteries by pins have been reported but are uncommon.¹ Poorly-placed external fixator pins may impede access for definitive soft-tissue cover in severe fractures. Reconstruction may be further complicated if they impinge on vessels. Pseudoaneurysm is a rare complication of impingement.² Pins that impinge on a vascular pedicle cause injury either acutely by perforation or by irritation and inflammation of the vessel wall, resulting in erosion and aneurysm formation.^1,3 The deep femoral artery is easily damaged by a lateral pin protruding from the medial cortex. It is dangerous to use a Hoffmann pin in this area because even if correctly placed, its sharp tip protrudes at least 1 cm from the cortex.⁴ A Doppler or ultrasound scan may diagnose a pseudoaneurysm but we recommend that angiography should be performed before contemplating vascular reconstruction. A false aneurysm may develop up to several months after external fixator insertion and usually presents as a painful swelling or bleeding from the pinhole. Heightened awareness of the complication may lead to early recognition and treatment.

REFERENCES

1. Mercer NSG, Moss ALH. Impingement of vascular pedicles by external fixator pins. Injury 1989;20:114.[Medline]

2. Barba L, Augereau B, Apoil A. Faux aneurysme de l'artere femorale profonde apres fixateur externe pour fracture ouverte de la diaphyse femorale. Ann Chir 1981;35:48.[Medline]

3. Browner BD. Pitfalls in the management of open fractures with Hoffmann external fixation. Ann Chir Gynaecol 1983;72:303.[Medline]

4. Paul MA, Patka P, Van Heuzen EP, Koonen AR, Rauwerda J. Vascular injury from external fixation: case reports. J Trauma 1992;33:917–20.[Medline]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Satish R Das Anil Gangadhar Tendolkar Ashutosh A Hardikar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Das, S. R Articles by Hardikar, A. A Search for Related Content PubMed Articles by Das, S. R Articles by Hardikar, A. A