Delayed presentation of anterior tibial artery pseudoaneurysm causing distal ischemia – A case report with review of literature

A pseudoaneurysm is a rare complication involving the vasculature and may be limb threatening if not treated. Pseudoaneurysm typically occurs when there is a breach in the vessel wall such that the blood leaks through the inner wall but is contained by the adventitia or surrounding perivascular soft tissue. These may be caused due to trauma to the vessel (either due to fractures, bony fragments), following endovascular therapy , or infective etiology, or other causes. Tibial and pedal artery aneurysms occur in the setting of penetrating trauma, fractures, or iatrogenic injury during orthopaedic surgery or peripheral interventions. Those causing significant symptoms must be repaired with autologous vein bypass grafts if there is distal ischemia. If other tibial arteries are patent, a simple ligation will also suffice. Coil embolization and conservative management resulting in spontaneous thrombosis of small pseudoaneurysms, have also been reported. We report a case of a 51 year old male with right Anterior Tibial Artery pseudoaneurysm which had developed over several years after a trauma with the patient presenting to us only after he started having symptoms of distal ischemia.