|Year : 2020 | Volume
| Issue : 3 | Page : 300-301
Blunt traumatic true aneurysm of lateral plantar artery: A rare entity
Department of Thoracic and Vascular Surgery, ARR Hospital, Cuddalore, Tamil Nadu, India
|Date of Submission||02-Jan-2020|
|Date of Decision||04-Jan-2020|
|Date of Acceptance||12-Jan-2020|
|Date of Web Publication||12-Sep-2020|
Department of Thoracic and Vascular Surgery, ARR Hospital, Cuddalore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Traumatic lateral plantar artery aneurysms to the foot is a rare entity, for the amount of trauma the foot is subjected. In the literature, till now, cases reported were after penetrating injury to the sole or associated with bony injuries. No cases of blunt trauma incidence have been reported till now. Management is by open surgical repair or endovascular repair. Pain on walking was the reason the patient attended us. In this study, we discuss a case of blunt traumatic lateral plantar artery aneurysm with its presentation and management.
Keywords: Blunt trauma, lateral plantar artery aneurysm, surgical repair
|How to cite this article:|
Elamurugan E. Blunt traumatic true aneurysm of lateral plantar artery: A rare entity. Indian J Vasc Endovasc Surg 2020;7:300-1
| Introduction|| |
Injury to the plantar arteries are often rare owing to its anatomical location and course of the vessels. Lateral plantar artery pseudoaneurysms have been reported with postsurgical interventions such as plantar fasciotomy, calcaneal osteotomy, percutaneous pinning for Lisfranc fracture–dislocation 1, or associated with bony injuries such as calcaneal fracture.,,, A few cases of plantar artery aneurysm following foot laceration are reported in children.
| Case Report|| |
A 38-year-old male presented with complaints of pain in the left foot on walking for 2 weeks. There was a history of polytrauma (head and thoracic injuries) after a self-fall from a two-wheeler, which was managed conservatively 2 months back. The patient was a known case of schizophrenia on irregular medications.
On clinical examination, the patient had a pulsatile swelling over the plantar aspect of the midfoot without any sign of trauma or distal neurovascular deficit. A left lower limb ultrasound of the foot was done, which detected a left plantar artery aneurysm with thrombus [Figure 1]. Under regional anesthesia, via a curvilinear incision, from the medial aspect of the heel to the forefoot, the aneurysm was approached. Subcutaneous flap was raised and the plantar fascia was incised [Figure 2]. The flexor digitorum muscle was retracted medially, and the aneurysm was found to be arising from the lateral planter artery [Figure 3]. Aneurysm excision with ligation of the proximal and distal ends of the artery was done after confirming the backflow from the distal end. Postprocedure, the patient was clinically and symptomatically better at 1-month follow-up. Histopathological examination revealed a uniloculated cystic mass measuring 2 cm × 1.5 cm × 1.2 cm with thrombus suggestive of an arterial true aneurysm with thrombus.
| Discussion|| |
The clinical spectrum of plantar artery aneurysms is highly variable between asymptomatic and symptomatic. These patients develop symptoms secondary to thromboembolism, rupture of an aneurysm, and due to mass effect over the nerves. In the literature, the occurrence of aneurysm has been predominantly due to penetrating injury to the sole either iatrogenic, associated with fractures, or foreign body induced.,,,, Symptoms of mass effect occur if the size of the aneurysm is large and causes stretching of nerves. Sensory deficits, in this case, could be due to compression of lateral plantar nerve because of its close approximation with the artery. Rupture can occur in patients with vulnerable scar due to previous interventions. The lateral plantar artery is at high risk for trauma compared to the medial plantar artery due to its superficial location. Diagnosis is confirmed by duplex sonography, computed tomography (CT) angiography, or magnetic resonance angiogram. Ultrasonography confirms the diagnosis and identifies the size of the aneurysm, the presence of thrombus, and distal flow. CT angiography is helpful in planning for endovascular management. Endovascular management has been employed with similar results as open repair.
| Conclusion|| |
Lateral plantar artery aneurysms can present in myriad ways and should be considered as a differential diagnosis in foot pain. Compression symptoms and rupture are common presentations. Open surgical management is still an effective modality in the management of these patients. It is important to keep aneurysms as a possible differential diagnosis of foot masses in all age groups.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]