Abstract

Case Report

Superior Gluteal Artery Pseudoaneurysm following a Periacetabular Osteotomy

Tess Szekelyi, Xavier Lannes, Mouas Jammal, Salah Dine Qanadli and Michael Wettstein*

Published: 01 March, 2024 | Volume 8 - Issue 1 | Pages: 001-004

Periacetabular Osteotomy (PAO) is the gold standard for the treatment of hip dysplasia or acetabular retroversion. Due to the proximity of intra-pelvic arteries, there is a risk of iatrogenic vascular injuries, which can present with a delay and should be part of the differential diagnosis of significant pain following a PAO. 
We present the case of a never-described vascular injury following a periacetabular osteotomy in a 25-year-old woman who presented with gluteal pain 3 weeks after surgery. A delayed diagnosis of a pseudoaneurysm of the superior gluteal artery was made and successfully treated by embolization. The lesion is most probably related to the tip of a screw or to the drilling process.

Read Full Article HTML DOI: 10.29328/journal.aceo.1001018 Cite this Article Read Full Article PDF

Keywords:

Hip dysplasia; Periacetabular osteotomy; Vascular injury; Pseudoaneurysm; Embolization; Superior gluteal artery; Screw position

References

  1. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988 Jul;(232):26-36. PMID: 3383491.
  2. Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009 Aug;467(8):2041-52. doi: 10.1007/s11999-009-0842-6. Epub 2009 Apr 21. PMID: 19381741; PMCID: PMC2706361.
  3. Swarup I, Ricciardi BF, Sink EL. Avoiding Complications in Periacetabular Osteotomy. JBJS Rev. 2015 Nov 24;3(11):e4. doi: 10.2106/JBJS.RVW.O.00023. PMID: 27490913.
  4. Toki S, Nagamachi A, Yonezu H, Adachi K, Inoue K, Naito M. Injury to the Obturator Artery During Periacetabular Osteotomy: A Case Report. JBJS Case Connect. 2016 Jan-Mar;6(1):e9. doi: 10.2106/JBJS.CC.O.00078. PMID: 29252715.
  5. Brenoe AS, Andersen PE, Overgaard S. [Endovascular embolisation of severe bleeding in connection with periacetabular osteotomy]. Ugeskr Laeger. 2006; 168: 14531454.
  6. Beck M, Leunig M, Ellis T, Sledge JB, Ganz R. The acetabular blood supply: implications for periacetabular osteotomies. Surg Radiol Anat. 2003 Nov-Dec;25(5-6):361-7. doi: 10.1007/s00276-003-0149-3. Epub 2003 Aug 16. PMID: 12923665.
  7. Kamada S, Naito M, Shiramizu K, Nakamura Y, Kinoshita K. Is the obturator artery safe when performing ischial osteotomy during periacetabular osteotomy? Int Orthop. 2011 Apr;35(4):503-6. doi: 10.1007/s00264-010-1064-y. Epub 2010 Jun 16. PMID: 20556381; PMCID: PMC3066328.
  8. Agarwal M, Giannoudis PV, Syed AA, Hinsche AF, Matthews SJ, Smith RM. Pseudoaneurysm of the inferior gluteal artery following polytrauma: diverse presentation of a dangerous complication: a report of two cases. J Orthop Trauma. 2003 Jan;17(1):70-4. doi: 10.1097/00005131-200301000-00013. PMID: 12499973.
  9. Romero L, Serrallé C, Fernández Noya J, González P, Mosquera NJ. Superior Gluteal Artery Pseudoaneurysm: Two Cases Report and Review of the Literature. Port J Card Thorac Vasc Surg. 2021 Nov 7;28(3):47-49. doi: 10.48729/pjctvs.194. PMID: 35333469.
  10. Ailaney N, O'Connell R, Giambra L, Golladay G. Superior gluteal artery pseudoaneurysm following intramedullary nailing of an atypical femoral fracture. BMJ Case Rep. 2019 Oct 23;12(10):e231490. doi: 10.1136/bcr-2019-231490. PMID: 31645404; PMCID: PMC6827729.
  11. Khela M, Kasir R, Lokken RP, Clark AJ, Theologis AA. Bilateral dual iliac screw pelvic fixation for adult spinal deformity: a case report of a superior gluteal artery pseudoaneurysm secondary to aberrant iliac screw trajectory. Spine Deform. 2023 Oct 26. doi: 10.1007/s43390-023-00774-y. Epub ahead of print. PMID: 37882967.
  12. Kim WY, Lee SW, Kim KS, Lee JY. Superior Gluteal Artery Pseudoaneurysm Caused by Pelvic C-Clamp Blind Application: A Case Report. Hip Pelvis. 2017 Jun;29(2):145-149. doi: 10.5371/hp.2017.29.2.145. Epub 2017 Jun 2. PMID: 28611967; PMCID: PMC5465397.
  13. Maled I, Velez R, Lopez R, Batalla L, Caja VL. Pseudoaneurysm of the superior gluteal artery during iliosacral screw fixation. Acta Orthop Belg. 2007 Aug;73(4):544-7. PMID: 17939491.
  14. Stavrakakis IM, Magarakis GE, Liodakis G, Tavlas E, Tsetis DK. Sciatic Nerve Palsy due to a Superior Gluteal Artery Pseudoaneurysm PostBone Marrow Biopsy: A Case Report and Review of the Literature. J Orthop Case Rep. 2018 Jul-Aug;8(4):74-77. doi: 10.13107/jocr.2250-0685.1168. PMID: 30687669; PMCID: PMC6343557.
  15. Sullivan CM, Regi JM. Pseudoaneurysm of the superior gluteal artery following bone marrow biopsy. Br J Haematol. 2013 Apr;161(2):289-91. doi: 10.1111/bjh.12216. Epub 2013 Jan 29. PMID: 23356434.
  16. Slullitel PA, Llano L, García-Ávila C, Diaz-Dilernia F, Piccaluga F, Buttaro M, Zanotti G, Comba F. Unaddressed arterial injuries in revision total hip arthroplasty: mortality outcomes of a low-prevalence complication. Int Orthop. 2020 Jan;44(1):23-29. doi: 10.1007/s00264-019-04358-2. Epub 2019 Jun 20. PMID: 31222421.
  17. Stephen DJ. Pseudoaneurysm of the superior gluteal arterial system: an unusual cause of pain after a pelvic fracture. J Trauma. 1997 Jul;43(1):146-9. doi: 10.1097/00005373-199707000-00037. PMID: 9253929.
  18. Rivera PA, Dattilo JB. Pseudoaneurysm. In StatPearls; Treasure Island (FL). 2024.
  19. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008 Jul;466(7):1633-44. doi: 10.1007/s11999-008-0242-3. Epub 2008 May 1. PMID: 18449617; PMCID: PMC2505253.
  20. Shetty M. Acute Pelvic Pain: Role of Imaging in the Diagnosis and Management. Semin Ultrasound CT MR. 2023 Dec;44(6):491-500. doi: 10.1053/j.sult.2023.10.004. Epub 2023 Oct 12. PMID: 37832696.
  21. Taif S, Derweesh A, Talib M. Superior gluteal artery pseudoaneurysm presenting as a gluteal mass: case report and review of literature. J Clin Imaging Sci. 2013 Oct 29;3:49. doi: 10.4103/2156-7514.120805. PMID: 24228217; PMCID: PMC3823385.
  22. Nachbur B, Meyer RP, Verkkala K, Zürcher R. The mechanisms of severe arterial injury in surgery of the hip joint. Clin Orthop Relat Res. 1979 Jun;(141):122-33. PMID: 477093.

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Figure 1

Figure 5

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?