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A 31-year-old man was admitted with 2 months’ history of right calf pain and tenderness. On palpation a pulsating
swelling was present, and the circumference of the right calf was 10 cm greater than
that of the left calf. The ankle-brachial index of the right leg was 0.8, the pulse
of the posterior tibial artery was diminished, and that of the dorsalis pedis absent.
There was no history of recent trauma; however, the patient’s medical history included
a medial mid calf stab wound 4 years ago. Color Duplex scan demonstrated a false aneurysm
of the posterior tibial artery. Computed tomography (CT) was performed to better image
the false aneurysm, and its maximum diameter was measured at 8 cm (Fig 1, Fig 2). On-table arteriography and the subsequent surgical exploration confirmed the presence
of a large pseudoaneurysm of the posterior tibial artery (Fig 3, Fig 4). The pseudoaneurysm was totally removed, the posterior tibial artery was repaired
with an end-to-end anastomosis, and the patient made an uneventful recovery.
Fig 1CT scan showing a large pseudoaneurysm measuring 8 cm in its maximum diameter.
Delayed presentation of 50 years after a World War II vascular injury with intraoperative localization by Duplex ultrasound of a traumatic false aneurysm.
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