A rare case of submassive pulmonary embolism after spontaneous rupture of superficial femoral artery pseudoaneurysm
DOI:
https://doi.org/10.18203/2349-2902.isj20263005Keywords:
Pseudoaneurysm, Superficial femoral artery, Venous thromboembolism, Thrombin Injection, Endovascular therapyAbstract
Spontaneous rupture of a superficial femoral artery (SFA) pseudoaneurysm without prior trauma or intervention is exceedingly rare. This report includes a 45-year-old man with morbid obesity (BMI 38) who presented with acute left lower extremity pain and swelling after experiencing a “pop” in his posteromedial thigh while bending. Imaging revealed a ruptured distal SFA branch pseudoaneurysm with a large hematoma, successfully treated with thrombin injection. On postoperative day one, he developed bilateral pulmonary emboli with right heart strain, progressing to submassive pulmonary embolism by day three. This case highlights hematoma-induced venous compression as a potential mechanism for venous thromboembolism.
References
Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics. 2005;25 Suppl 1:S173-89.
Virchow R. Thrombosis and embolism (1846–1856). Matzdorff AC, Bell WR, translators. Canton (MA): Science History Publications; 1998.
Giannoukas AD, Labropoulos N, Burke P, Fitridge R, Ani M, Nicolaides AN. Venous stasis and thrombosis due to external compression. Eur J Vasc Endovasc Surg. 2000;19(3):235-8.
Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Sicard GA. Spontaneous superficial femoral artery pseudoaneurysm. J Vasc Surg. 1997;26(6):1072-5.
Mahmoud MZ, Al-Saadi M, Salah A, Al-Jazazz A, Al-Enezi M, Al-Shammari A, et al. Spontaneous arterial pseudoaneurysms: etiology and management. Vasc Health Risk Manag. 2015;11:147-56.
Kakkos SK, et al. Mechanisms of venous thrombosis. Int Angiol. 2012;31(2):123-34.
O'Sullivan GJ, Semba CP, Montgomery HG, Kee ST, Dake MD. May-Thurner syndrome: diagnosis and management. Vasc Endovascular Surg. 2007;41(5):375-83.
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-52.
Tapson VF, et al. Catheter-directed therapy for acute pulmonary embolism. Circulation. 2019;139(9):1159-73.