Department of Health Sciences, Orthopedic Oncology and Reconstructive Surgery Unit, Careggi University Hospital, University of Florence, Florence, Italy.
Vascular Surgery Unit, Careggi University Hospital, Florence, Italy.
Am J Case Rep. 2023 Feb 7;24:e937113. doi: 10.12659/AJCR.937113.
BACKGROUND This case report describes a giant pseudoaneurysm that grew in size during the years following surgical treatment of a popliteal artery aneurysm, eventually causing a femoral fracture. Bone fractures secondary to vascular injuries are rarely described in the literature. CASE REPORT A 54-year-old man underwent surgical ligation and bypass for left popliteal artery aneurysm. Seven years later, he suffered a left distal femur pathologic fracture surrounded by a giant soft-tissue mass. The patient came to us with a diagnostic hypothesis of angiosarcoma from another hospital at imaging evaluation. After computed tomography angiography (CTA) and angio-magnetic resonance imaging (MRI), we made a diagnosis of femoral pathologic fracture caused by a giant pseudoaneurysm of a treated popliteal artery aneurysm refilled by an aberrant anterior tibial artery (IIA2, Kim classification). We performed excision of the mass and open reduction and internal fixation, with anatomic plate, of the fracture. Fracture healing and good functional outcome were observed at follow-up. CONCLUSIONS A possible complication of surgical treatment of popliteal artery aneurysms is refilling of the excluded aneurysm due to collateral blood flow or, such as in the present case, aberrant vessels. Therefore, the knowledge of anatomical variants of the vessels is important in surgery. Follow-up evaluation after surgery is advisable and a growing mass should be further investigated with an angio-CT scan. In case of a non-pulsating soft-tissue mass causing pathologic bone fracture, a biopsy is mandatory to exclude malignancy.
本病例报告描述了一例巨大假性动脉瘤，在接受腘动脉动脉瘤手术治疗后的数年中不断增大，最终导致股骨干骨折。血管损伤引起的骨折在文献中很少描述。
一名 54 岁男性因左侧腘动脉动脉瘤接受了手术结扎和旁路治疗。7 年后，他出现左侧股骨远端病理性骨折，周围伴有巨大软组织肿块。患者因另一医院影像学检查提示为血管肉瘤来我院就诊。行 CT 血管造影（CTA）和血管磁共振成像（MRI）后，我们诊断为治疗后的腘动脉动脉瘤的巨大假性动脉瘤（Kim 分类 IIA2）再通引起的股骨病理性骨折，其异常的胫前动脉（IIA2）参与供血。我们进行了肿块切除和骨折切开复位内固定，使用解剖钢板。随访时观察到骨折愈合和良好的功能结果。
腘动脉动脉瘤手术治疗的一种可能并发症是由于侧支血流或如本例中异常血管导致排除的动脉瘤再通。因此，了解血管的解剖变异在手术中很重要。手术后进行随访评估是明智的，如果出现导致病理性骨折的不断增大的软组织肿块，应进一步进行血管 CT 扫描检查。如果出现非搏动性软组织肿块并导致病理性骨折，必须进行活检以排除恶性肿瘤。
