Image in surgery| Volume 139, ISSUE 3, P446-447, March 2006

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Delayed presentation of a posterior tibial false aneurysm

      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.
      Figure thumbnail gr1
      Fig 1CT scan showing a large pseudoaneurysm measuring 8 cm in its maximum diameter.
      Figure thumbnail gr2
      Fig 2CT reconstruction showing the position and extent of the pseudoaneurysm.
      Figure thumbnail gr3
      Fig 3On-table arteriography showing the false aneurysm originating off the posterior tibial artery.
      Figure thumbnail gr4
      Fig 4Intraoperative findings.
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