Dincal Turgut, Gencer Batuhan, Cincin Altug, Gulabi Deniz
Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, İstanbul,Türkiye.
Department of Cardiology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye.
Ulus Travma Acil Cerrahi Derg. 2025 Feb;31(2):202-206. doi: 10.14744/tjtes.2025.70124.
A popliteal pseudoaneurysm following total knee arthroplasty is a rare but potentially life-threatening complication. The most critical step in diagnosing popliteal pseudoaneurysms is maintaining a high level of suspicion and conducting a clinical assessment. The presence of a pulsatile mass in the popliteal region, edema, ecchymosis in the leg, unusual and persistent posterior knee pain, swelling, and paresthesia are diagnostically valuable indicators for popliteal pseudoaneurysms. Lower extremity venous Doppler ultrasonography and computed tomographic angiography are valuable diagnostic tools for identifying pseudoaneurysms. This case report describes a patient who presented with clinically inconsistent pain on the first postoperative day following primary total knee arthroplasty and was subsequently diagnosed with a popliteal pseudoaneurysm. Additionally, a review of the literature on this topic is provided. An 81-yearold woman with a history of nocturnal knee pain and significant impairment in daily activities underwent total knee arthroplasty. On the first postoperative day, she reported discomfort in the lower extremities and posterior knee pain that did not align with her clinical presentation. Palpation of the distal pulses revealed no abnormalities, and no additional symptoms were observed. Venous Doppler ultrasonography of the patient's left lower extremity identified a spherical, low echogenic structure with pulsation, approximately 3.5 × 2.5 cm in size, located near the prosthesis and adjacent to the popliteal artery. This finding confirmed the diagnosis of a pseudoaneurysm. Following a comprehensive assessment and given the evidence of a neck size exceeding 5 mm and the potential for dissection in the vicinity of the pseudoaneurysm, the decision was made to implant a covered stent. In cases of severe pain that is inconsistent with the clinical and postoperative period, popliteal pseudoaneurysms should be considered.
全膝关节置换术后腘窝假性动脉瘤是一种罕见但可能危及生命的并发症。诊断腘窝假性动脉瘤最关键的步骤是保持高度怀疑并进行临床评估。腘窝区域出现搏动性肿块、腿部水肿、瘀斑、异常且持续的膝关节后方疼痛、肿胀和感觉异常是腘窝假性动脉瘤有诊断价值的指标。下肢静脉多普勒超声和计算机断层血管造影是识别假性动脉瘤的重要诊断工具。本病例报告描述了一名患者,在初次全膝关节置换术后第一天出现临床症状不符的疼痛,随后被诊断为腘窝假性动脉瘤。此外,还提供了关于该主题的文献综述。一名81岁女性,有夜间膝关节疼痛病史且日常活动严重受限,接受了全膝关节置换术。术后第一天,她报告下肢不适和膝关节后方疼痛,与临床表现不符。触诊远端脉搏未发现异常,也未观察到其他症状。对患者左下肢进行静脉多普勒超声检查,发现一个球形、低回声结构,有搏动,大小约为3.5×2.5厘米,位于假体附近且与腘动脉相邻。这一发现证实了假性动脉瘤的诊断。经过全面评估,鉴于颈部尺寸超过5毫米且假性动脉瘤附近有夹层形成的可能性,决定植入覆膜支架。对于与临床和术后情况不符的严重疼痛病例,应考虑腘窝假性动脉瘤。