Posterior Tibial Artery Pseudoaneurysm following Orthopedic Surgery: a Rare Complication

Increase in trauma and aging in recent decades has been associated with an increase in orthopedic operations in the limbs and their concomitant iatrogenic vascular complications. Although vascular injuries during orthopedic operations are uncommon, timely diagnosis and treatment is essential. These injuries can occur due to laceration, compression, or traction of the vessels in proximity to bony structures such as vertebrae, hip and knee joints, and long bones. Primary signs are bleeding or ischemia. The best results will be obtained with prompt diagnosis and treatment; otherwise, there is a risk of complications such as pseudoaneurysm or limb loss. The presented case is a 22-year-old male with a history of right tibial fracture following a motorcycle accident one year before, which was treated with internal plate fixation. Following the operation, an enlarging mass developed in the posterior aspect of his leg. Upon evaluation, it was noted that a screw used for internal fixation had injured the posterior tibial artery and led to tibial artery pseudoaneurysm. Surgical treatment was done. Such a complication has not been reported in the literature. In the presence of even minimal ischemia following bone trauma, vascular evaluation and angiography before any orthopedic operation is critical, and it is recommended that management in such cases be performed in centers where reconstructive vascular surgery is available.