Hindawi Publishing Corporation Case Reports in Orthopedics Volume 2013, Article ID 569586, 3 pages http://dx.doi.org/10.1155/2013/569586 Case Report Pseudoaneurysm of the Anterior Tibial Artery following Tibio-Talar-Calcaneum Fusion with a Retrograde Nail: A Rare Case and Literature Review Simon Craxford, Saravana V. Karuppiah, and Stephen Milner Department of Orthopaedics Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK Correspondence should be addressed to Simon Craxford; simon.craxford@nhs.net Received 17 June 2013; Accepted 7 July 2013 Academic Editors: M. T. Hirschmann, M. Pirpiris, H. G. Said, and T. Yasuda Copyright © 2013 Simon Craxford et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. his study reports the case of an 87-year-old woman who presented with a nonresolving haematoma 13 weeks following tibiotalar arthrodesis surgery on her right ankle using a retrograde nail. his was revealed by angiography to be a pseudoaneurysm of the anterior tibial artery. he patient subsequently underwent endovascular stenting of the pseudoaneurysm and has had a successful recovery. his case highlights the need for awareness of both the normal arterial supply to the leg and ankle as well as the potential for anatomical variations. Arterial variation may be as high as 6.7% based on published indings from cadaveric studies. As pseudoaneurysm is a rare complication, a high index of suspicion is needed in order to avoid a missed or delayed diagnosis. We urge surgeons to keep in mind the potential for pseudoaneurysm when a patient presents with a nonresolving haematoma and arrange appropriate further investigations as needed. 1. Introduction A pseudoaneurysm is a rare complication following ankle surgery. Cases of pseudoaneurysm following ankle arthroscopy [1], application of Ilizarov external ixator [2], fracture [3], and sprain of the ankle [4] have all been previously reported. We present a case of pseudoaneurysm of the anterior tibial artery ater tibio-talar-calcaneal arthrodesis using a retrograde nail. he patient was treated with endovascular stenting and had a full recovery. We also review the potential variations in the course of the anterior tibial artery. 2. Case Presentation An 87-year-old woman in good previous health with known rheumatoid arthritis presented to the orthopaedic outpatients department. She complained of long standing pain from her right ankle. She had previously successfully undergone an elective Right Subtalar Arthrodesis eight years ago, (as shown in Figure 1) however, she was now symptomatic from tibiotalar ankle arthritis. A tibio-talar-calcaneal arthrodesis was performed with a retrograde nail through the heel and the old arthrodesis screws were removed. here were no noted intraoperative or immediate postoperative complications. As per standard departmental operating procedure, she was immobilised in plaster for 6 weeks. At followup six weeks ater surgery, a haematoma was noted at the site of the proximal locking screw, but her wound was otherwise healing well. A fol- lowup at 13 weeks showed complete union of the arthrode- sis. She, however, complained of a throbbing sensation on the leg. On examination pulsatile swelling measuring 6 cm by 6 cm was seen over the lower anterolateral region of her shin. here was an audible bruit on auscultation. Angiogram demonstrates a large pseudoaneurysm aris- ing from the distal anterior tibial artery, as shown in Figure 2. he peroneal artery was patent. he posterior tibial artery is occluded distally although this reforms at the ankle joint via collaterals from the peroneal artery. She subsequently underwent stenting with a 3.5 mm Jomed covered stent on a 0.014 system, successfully deployed across the origin of the pseudoaneurysm. Postprocedure imaging demonstrated