Back to 2024 Abstracts
Multiple Lower Extremity Exostoses Causing Concurrent Pseudoaneurysm and Thrombosis in a Young Female
Anthony L Grzeda, Robert J Esther, Mark A Farber, Ehsan Benrashid
University of North Carolina, Chapel Hill, NC
Background
Arterial pathology is exceedingly uncommon in the pediatric population. Bony exostoses are hereditary, overwhelmingly more common in young males, and rarely reported as a source of isolated lower extremity arterial pseudoaneurysm or thrombosis. Extrinsic compression, causing repetitive vascular injury, can cause arterial and/or venous pathology. Here, we present the case of a young female with an acutely ischemic left lower extremity in concert with a popliteal artery pseudoaneurysm and deep venous thrombosis (DVT) due to multiple bony exostoses.
Methods
The patient is a 15-year-old female that presented to an outside facility with acute left knee pain and swelling, with plain films revealing multiple osteochondromas in her distal left femur and proximal tibia. No further imaging was obtained, and she was discharged. Three days later, on outpatient orthopedics evaluation, she received a venous duplex demonstrating acute left lower extremity DVT, mobile thrombus in her below- knee popliteal artery, and an above-knee left popliteal artery pseudoaneurysm with contained rupture, prompting hospital admission and joint orthopedics and vascular evaluation. The patient had normal motor and sensory function, and cross-sectional imaging via CT-angiography confirmed compression by the exostoses (
Figure 1). She was subsequently recommended for a combined vascular/orthopedics intervention in which above and below knee left popliteal artery exposures were performed, the osteochondromas resected, and pseudoaneurysm repair with concomitant thromboembolectomy. This was accomplished by vein patch repair of the left above-knee popliteal artery, and balloon embolectomy of the below knee popliteal artery and tibial vessels (
Figure 2).
ResultsThe patient recovered well and was discharged on postoperative day two on oral anticoagulation. Follow up revealed resolution of left lower extremity DVT and popliteal pseudoaneurysm, with normalization of ankle-brachial indices and toe pressures. Bony pathology returned as osteochondroma, and symptoms have completely abated with the resumption of normal activity.
Conclusions
Exostoses of the lower extremity typically result in either unilateral DVT, pseudoaneurysm, or thrombosis, and are more common in young males. Here we present the rare combination of the three aforementioned pathologies in a young female and recommend that in the presence of multiple vascular pathologies in a young patient, further investigation via cross sectional imaging performed to rule out compressive pathology prior to operative intervention. This was successfully managed with vein patch angioplasty of the pseudoaneurysm, conventional balloon thromboembolectomy, and anticoagulation alone for DVT.
Back to 2024 Abstracts
