title: Treatment options of crural pseudoaneurysms.
abstract: BACKGROUND
  Pseudoaneurysms (PAs) of crural arteries represent rare complications of vascular interventions or surgery. Management of crural PAs includes different treatment options, conservative treatment as well as open surgery or endovascular procedures. We reviewed our experience.
  
  
  METHODS
  We retrospectively analysed all patients who were diagnosed with crural PAs since 2003. We evaluated etiology, treatment and outcome. Endpoints were target vessel patency, vascular re-intervention and limb loss.
  
  
  RESULTS
  A total of 30 patients were diagnosed with crural PAs. PA was caused by vascular intervention in 27 patients (90 %): open balloon thrombectomy (n = 25), subfascial endoscopic perforator vein surgery (n = 1) and transcutaneous catheter-assisted thrombus aspiration (n = 1). In 3 patients (10 %) it was caused by orthopaedic surgical procedures. Location of crural PAs were peroneal artery (n = 11; 36.7 %), posterior tibial artery (n = 10; 33.3 %), anterior tibial artery (n = 5; 16.7 %), and tibioperoneal trunk (n = 4; 13.3 %). Treatment of crural PAs included open surgery (n = 3; 10 %), endovascular procedures (n = 13; 43.3 %) such as endograft implantation (n = 9) or coil embolisation (n = 4), and conservative management (n = 14; 46.7 %). After a median follow-up period of 7 months (range: 0 - 46 months) 8 of 9 endografts were occluded, in none of these patients a minor or a major amputation was necessary. None of the surgically, endovascularly and conservatively treated patients needed a re-intervention for crural PA. A major amputation was necessary in 4 patients due to progression of peripheral arterial disease; none was a directly consequence of the crural PA.
  
  
  CONCLUSIONS
  Crural PAs are mainly caused by vascular intervention, most frequently by catheter thrombectomy. As a consequence, we recommend fluoroscopic-assisted balloon thrombectomy over a guide wire as routine technique. In many cases of crural PAs, conservative management is sufficient. The choice of treatment of crural PAs depends on size, location and associated symptoms. Endovascular treatment using endografts is limited by poor long-term patency.
authors.affiliation: Department of Vascular Surgery, Medical University of Innsbruck, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gratl
authors.affiliation: Department of Vascular Surgery, Medical University of Innsbruck, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Klocker
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Glodny
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Austria.
authors.forename: Marius
authors.initials: M
authors.lastname: Wick
authors.affiliation: Department of Vascular Surgery, Medical University of Innsbruck, Austria.
authors.forename: Gustav
authors.initials: G
authors.lastname: Fraedrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects
keywords: arterial pseudoaneurysm; crural; endograft; iatrogenic; thrombectomy