Skip to main content
SpringerLink
Log in

Crural Artery Traumatic Injuries: Treatment with Embolization

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

The purpose of this paper is to report our experience with the endovascular treatment of crural arterial injuries using transcatheter and direct embolization techniques. A total of eight consecutive patients have been treated during a 7-year period. Six males and two females, mean age 32 years (range, 15–56 years), presented with penetrating trauma to the lower extremities. Mechanisms of injuries were stab wounds in six patients, gun shot wound in one patient, and iatrogenic injury in one patient. Five patients presented with acute trauma, while three patients presented with delayed injuries. Crural arterial injuries encountered included pseudoaneurysms with arteriovenous fistulas (n = 6), pseudoaneurysms with vessel transections (n = 2), and pseudoaneurysm (n = 1). Proximal and distal embolization with coils was used in three cases, proximal embolization with coils in three cases, percutaneous thrombin injection in one case, and liquid n-butyl cyanoacrylate in one case. Complete exclusion of the lesions was accomplished by sacrifice of one crural vessel in seven cases and of two crural vessels in one case. Two cases of delayed injuries required combined coil and liquid embolization techniques for lesion exclusion. A minor complication (groin hematoma) occurred in one patient, no distal ischemia was seen, and no amputations were required. Mean follow-up was 61 days (range, 1–180 days). One pseudoaneurysm treated with thrombin injection recurred and required surgical excision. We conclude that transcatheter embolization alone or in combination with different endovascular techniques is useful in the treatment of traumatic crural vessel injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Moniz MP, Ombrellaro MP, Stevens SL, Freeman MB, Diamond DL, Goldman MH (1997) Concomitant orthopedic and vascular injuries as predictors for limb loss in blunt lower extremity trauma. Am Surg 63(1):24–28

    PubMed  CAS  Google Scholar 

  2. Edwards H, Martin E, Nowygrod R (1982) Non operative management of a traumatic peroneal artery false aneurysm. J Trauma 22(4):323–326

    Article  PubMed  CAS  Google Scholar 

  3. Wolford H, Peterson SL, Ray C, Morgan SJ (2001) Delayed arteriovenous fistula and pseudoaneurysm after an open tibial fracture successfully managed with selective angiographic embolization. J Trauma 51(4):781–783

    PubMed  CAS  Google Scholar 

  4. Sugimoto T, Kitade T, Morimoto N, Terashima K (2004) Pseudoaneurysms of peroneal artery: treatment with transcatheter platinum coil embolization. Ann Thorac Cardiovasc Surg 10(4):263–265

    PubMed  Google Scholar 

  5. Rosa P, O’Donnell SD, Goff JM, Gillespie DL, Starnes B (2003) Endovascular management of a peroneal artery injury due to a military fragment wound. Ann Vasc Surg 17(6):678–681

    Article  PubMed  Google Scholar 

  6. Davis KA, Mansour MA, Kang SS, Labropoulos N, Esposito TJ, Silver GM, Reed RL (2000) Pseudoaneurysms of the extremity without fracture: treatment with percutaneous ultrasound-guided thrombin injection. J Trauma 49(5):818–821

    PubMed  CAS  Google Scholar 

  7. Griffith JF, Cheng JC, Lung TK, Chan M (1998) Pseudoaneurysm after high tibial osteotomy and limb lengthening. Clin Orthop Relat Res 354:175–179

    Article  PubMed  Google Scholar 

  8. Han KJ, Won YY, Khang SY (2004) Pseudoaneurysm after tibial nailing. Clin Orthop Relat Res 418:209–212

    Article  PubMed  Google Scholar 

  9. Young LP, Stanley A, Menzoian JO (2001) An anterior tibial artery aneurysm in a patient with neurofibromatosis. J Vasc Surg 33(5):1114–1117

    Article  PubMed  CAS  Google Scholar 

  10. Toyota N, Kimura F, Yoshida S, Mitsui N, Mochizuki T, Naito A, Ito K (1999) Peroneal artery aneurysm treated by transcatheter coil embolization and temporary balloon occlusion in Behcet’s disease. CardioVasc Interv Radiol 22:257–259

    Article  CAS  Google Scholar 

  11. Padberg FT Jr, Rubelowsky JJ, Hernandez-Maldonado JJ, Milazzo V, Swan KG, Lee BC, Hobson RW (1992) Infrapopliteal arterial injury: prompt revascularization affords optimal limb salvage. J Vasc Surg 16(6):877–885

    Article  PubMed  Google Scholar 

  12. Skudder PA, Gelfand ML, Blumenberg RM, Fulco J (1999) Tibial artery false aneurysm: uncommon result of blunt injury occurring during athletics. Ann Vasc Surg 13(6):589–591

    Article  PubMed  CAS  Google Scholar 

  13. Holleman JH, Killebrew LH (1982) Tibial artery injuries. Am J Surg 144(3):362–364

    Article  PubMed  Google Scholar 

  14. van Schaardenburgh P, Steenvoorde P, de Bruine JF, Viersma JH, Warmenhoven PG (2003) Thrombotic resolution of a traumatic pseudoaneurysm of the anterior tibial artery after external compression. J Trauma 55(3):561–565

    PubMed  Google Scholar 

  15. Shah PM, Mackey R, Babu SC, Kulkarni S, Clauss RH (1985) Pseudoaneurysm of anterior tibial artery after occlusion from blunt trauma: non operative management. J Trauma 25(7):656–658

    PubMed  CAS  Google Scholar 

  16. Ballard JL, Bunt TJ, Malone JM (1992) Management of small artery vascular trauma. Am J Surg 164:316–319

    Article  PubMed  CAS  Google Scholar 

  17. Wollstein R, Wolf Y, Sklair-Levy M, Matan Y, London E, Nyska M (2000) Obliteration of a late traumatic posterior tibial artery pseudoaneurysm by duplex compression. J Trauma 48(6):1156–1158

    Article  PubMed  CAS  Google Scholar 

  18. Corso R, Carrafiello G, Intotero M, Solcia M (2003) Large iatrogenic pseudoaneurysm of the posterior tibial artery treated with sonographically guided thrombin injection. AJR 180:1479–1480

    PubMed  Google Scholar 

  19. Sanchez FW, Bertozzi G (1994) Direct percutaneous embolization of a postembolectomy pseudoaneurysm. CardioVasc Interv Radiol 17(3):155–157

    Article  CAS  Google Scholar 

  20. Georgiadis GS, Deftereos SP, Eleftheriadou E, Zacharouli D, Lazarides MK (2006) Delayed presentation of a posterior tibial false aneurysm. Surgery 139(3):446–447

    Article  PubMed  Google Scholar 

  21. Albrecht RJ, Parra JR (2004) Traumatic peroneal artery pseudoaneurysm: use of preoperative coil embolization. J Vasc Surg 39(4):912

    Article  PubMed  Google Scholar 

  22. Owen RJ, Haslam PJ, Elliott ST, Rose JD, Loose HW (2000) Percutaneous ablation of peripheral pseudoaneurysms using thrombin: a simple and effective solution. CardioVasc Interv Radiol 23(6):441–446

    Article  CAS  Google Scholar 

  23. Hebrang A, Grga A, Brkljacic B, Drinkovic I (2001) Successful closure of large pseudoaneurysm of peroneal artery using transluminal temporary occlusion of the neck with the catheter. Eur Radiol 11:1206–1209

    Article  PubMed  CAS  Google Scholar 

  24. Ray CE , Johnson J, Cothren CC (2006) Endovascular repair of a large post-traumatic calf pseudoaneurysm and arteriovenous fistula. Mil Med 171(7):659–661

    PubMed  Google Scholar 

  25. Halabi AR, Kandzari DE (2005) The thrill is gone: catheter-based exclusion of a posttraumatic arteriovenous fistula with a covered stent graft. Catheter Cardiovasc Interv 66(1):27–33

    Article  PubMed  Google Scholar 

  26. De Roo RA, Steenvoorde P, Schuttevaer HM, Den Outer AJ, Oskam J, Joosten PP (2004) Exclusion of a crural pseudoaneurysm with a PTFE-covered stent. J Endovasc Ther 11:344–347 

    Article  PubMed  Google Scholar 

  27. Spark JI, Blanshard KS, Scott DJ (1996) Endovascular graft placement for a symptomatic iatrogenic peroneal arteriovenous fistula. Eur J Vasc Endovasc Surg 11(4):496–498

    Article  PubMed  CAS  Google Scholar 

  28. Spirito R, Trabattoni P, Pompilio G, Zoli S, Agrifoglio M, Biglioli P (2007) Endovascular treatment of a post-traumatic tibial pseudoaneurysm and arteriovenous fistula: case report and review of the literature. J Vasc Surg 45:1076–1079

    Article  PubMed  Google Scholar 

  29. van Hensbroek PB, Ponsen KJ, Reekers JA, Goslings JC (2007) Endovascular treatment of anterior tibial artery pseudoaneurysm following locking compression plating of the tibia. J Orthop Trauma 21(4):279–282

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA

    Jorge E. Lopera, Rajeev Suri, Marco Cura, Ghazwan Kroma & Fadi El-Merhi

Authors
  1. Jorge E. Lopera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajeev Suri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Cura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ghazwan Kroma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fadi El-Merhi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jorge E. Lopera.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lopera, J.E., Suri, R., Cura, M. et al. Crural Artery Traumatic Injuries: Treatment with Embolization. Cardiovasc Intervent Radiol 31, 550–557 (2008). https://doi.org/10.1007/s00270-008-9309-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-008-9309-5

Keywords

Search

Navigation