Deep femoral artery branch pseudoaneurysm formation and injury after hip fracture surgery: A case series and a literature review.

INTRODUCTION: Complications involving vascular injuries after hip fracture are rare, and the diagnosis and management of deep femoral artery (DFA) injuries are challenging. We reported 4 cases of DFA injuries after hip fracture surgery and aimed to discuss their early detection, treatment, and prevention.

METHODS: We reviewed 4 cases of deep femoral injury after hip fracture. Case 1: a 71-year-old woman suffered a fracture around a prosthesis. Cases 2-4: 2 men and 1 woman suffered subtrochanteric or intertrochanteric fracture. DFA branch pseudoaneurysm formation and injury were found via arteriography after surgery. All the patients were diagnosed with DFA branch pseudoaneurysm formation and injury. Percutaneous intervention therapy was used to block the pseudoaneurysms with coil or gel.

RESULTS: Among the cases, the main symptoms were severe pain or swelling with large-scale ecchymosis in the thigh or perineum. We used arterial duplex to diagnose pseudoaneurysm and treated the injury using interventional intravascular embolization. In Case 1, damage by the guide wire used during surgery, and over-treatment with anticoagulants, may have occurred. In Case 2, the guide wire was a possible contributing factor to injuries. In Case 3, the displaced lesser trochanter fragment may have damaged the vessel. Lastly, a drill bit was a contributing factor to the injuries in Case 4.

CONCLUSION: There are many definitive causes of DFA pseudoaneurysm formation and injuries. Such injuries can be diagnosed via digital subtraction angiography or CT angiography, and a thorough understanding of the anatomy of the femur and damages from reductions is important.