CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
AFRICA
e7
Case Report
A penetrating nail-prick injury of the lateral plantar artery
leading to pseudo-aneurysm formation and rupture
Emrah
Ş
i
ş
li, Ali
İ
hsan Hasde, Mustafa Mavi, Suat Dursun
Abstract
Pseudo-aneurysm in the plantar region is so rare that there
are only sporadic case reports in the literature. The aetiol-
ogy is usually either iatrogenic or stepping on a piece of
glass. In comparison to the medial plantar artery, the lateral
plantar artery is the most common arterial structure injured
in the plantar region due to its more superficial course and
it being less protected by the surrounding structures. With
variable presentation and different time intervals from injury
to diagnosis, the mechanism and penetration depth of the
injury is thought to have a major impact on the formation of
a pseudo-aneurysm. The aims of this article were to present
a case of a lateral plantar artery injury after stepping on a
construction nail, leading to pseudo-aneurysm formation and
rupture, and to review the literature with regard to the clinical
characteristics of these rare and overlooked cases.
Keywords:
leg injuries, vascular injuries, pseudo-aneurysm,
rupture, symptom evaluation
Submitted 7/5/13, accepted 13/5/14
Cardiovasc J Afr
2014;
25
: e7–e9
DOI: 10.5830/CVJA-2014-028
The incidence of plantar pseudo-aneurysm is so rare that there
are only sporadic case reports in the literature
1-5
(Table 1). The
aims of this article were to present a case of lateral plantar
artery injury after stepping on a construction nail, leading to
pseudo-aneurysm formation and rupture, and review of the
literature with regard to the clinical characteristics of these rare
and overlooked cases.
Case report
A 58-year-old female was referred to our emergency department
because of bleeding from the sole of her foot. On physical
examination, pulsatile bleeding from the enlarged lesion through
the eroded skin on the plantar surface of the left foot was noted
(Fig. 1A). The bleeding was controlled with manual compression
along with a tourniquet applied to the calf, and the patient was
urgently transferred to the operating room.
She had stepped on a rusty construction nail three weeks
earlier. Because there was no apparent bleeding, she had not
made much of her injury. On the third day, the patient had
attended a tertiary-level healthcare facility due to pain and
swelling. There the wound was dressed and treated medically.
The patient had not kept her follow-up appointment. She noted
‘I have been feeling my heartbeat in my sole for the last five days’.
In the operating room, the lesion was hastily evaluated with a
portable duplex ultrasound (Sonosite, MicroMaxx, Washington,
USA) using a linear phased array, 6–13 MHz bandwidth
transducer. In two dimensions, the lesion, with a diameter of 3.1
Department of Cardiovascular Surgery, Acıbadem Bakırköy
Hospital, Istanbul, Turkey
Emrah
Ş
i
ş
li, MD,
Clinics of Cardiovascular Surgery, Antakya State Hospital,
Hatay, Turkey
Ali
İ
hsan Hasde, MD
Mustafa Mavi, MD
Department of Radiology, Antakya State Hospital, Hatay,
Turkey
Suat Dursun, MD
Table 1. The demographic and clinical characteristics of the cases in the reviewed articles
Authors
No of
cases
Age
(years)/
gender Injury mechanism
Extensive
bleeding at the
time of injury
Time interval
from injury to
diagnosis Presentation
Plantar
artery
injured
Aneurysmal
sac dimention
(cm)
Procedure of
choice
Economou
et al.
(1993)
2
1 8/F Stepped on glass
Yes
3 weeks Haemorrhage LPA 2
Ligation, excision
Thornton
et al
. (2003)
5
2 5/F
11/F
Stepped on glass
Stepped on glass
Yes
Yes
8 weeks
3 weeks
Pulsatile mass
Pulsatile mass
LPA
LPA
2 × 2
8 × 4
Ligation
Ligation
Ptaszek
et al
. (2006)
4
1 18/M Iatrogenic
No
10 days Pulsatile mass LPA 2
Ligation
Bazea
et al
. (2009)
1
1 68/M Iatrogenic
No
11 days
Incidental
MPA* 2 × 1.5
Embolisation
Murakami
et al
. (2010)
3
1 26/M Stepped on glass
Yes
6 weeks
Pain
LPA 3.3 × 3 × 2 Embolisation
F: female, LPA: lateral plantar artery, M: male, MPA: medial plantar artery.
*Indicates small branches of the distal MPA.
