Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 7  |  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 Submission02-Jan-2020
Date of Decision04-Jan-2020
Date of Acceptance12-Jan-2020
Date of Web Publication12-Sep-2020

Correspondence Address:
Elamaran Elamurugan
Department of Thoracic and Vascular Surgery, ARR Hospital, Cuddalore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_1_20

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  Abstract 


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

How to cite this URL:
Elamurugan E. Blunt traumatic true aneurysm of lateral plantar artery: A rare entity. Indian J Vasc Endovasc Surg [serial online] 2020 [cited 2020 Oct 25];7:300-1. Available from: https://www.indjvascsurg.org/text.asp?2020/7/3/300/294900




  Introduction Top


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.[1],[2],[3],[4] A few cases of plantar artery aneurysm following foot laceration are reported in children.[5]


  Case Report Top


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.[1] 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.
Figure 1: Ultrasound of foot-pulsatile mass with thrombus

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Figure 2: Aneurysm with intact plantar fascia

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Figure 3: Lateral plantar artery looped with aneurysm

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  Discussion Top


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.[1],[2],[3],[4],[5] 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.[4] 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.[6]


  Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agarwal M, Harkless L, Hagino RT, Toursarkissian B. Lateral plantar artery aneurysm: A case report. J Am Podiatr Med Assoc 2007;97:480-2.  Back to cited text no. 1
    
2.
Ptaszek AJ, Aminian A, Schneider JR, Milos S. Lateral plantar artery pseudoaneurysm after calcaneal osteotomy: A case report. Foot Ankle Int 2006;27:141-3.  Back to cited text no. 2
    
3.
Sundararajan SR, Rajagopalakrishnan R, Rajasekaran S. Ruptured pseudoaneurysm of the lateral plantar artery after tibiotalocalcaneal fusion with retrograde nail-a rare complication. J Foot Ankle Surg 2018;57:393-5.  Back to cited text no. 3
    
4.
Thornton BP, Minion DJ, Quick R, Vasconez HC, Endean ED. Pseudoaneurysm of the lateral plantar artery after foot laceration. J Vasc Surg 2003;37:672-5.  Back to cited text no. 4
    
5.
Andacheh I, Chamseddin K, Kirkwood ML. Management of lateral plantar artery pseudoaneurysm after penetrating injury in children. Vasc Endovascular Surg 2015;49:247-9.  Back to cited text no. 5
    
6.
Beyer LP, Wohlgemuth WA, Müller-Wille R. Transarterial coil embolization of a symptomatic posttraumatic plantar pseudoaneurysm. Case Rep Radiol 2015;2015:453657.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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