PMC5451781_01
(a) Plain radiograph and (b) three-dimensional computed tomography scan acquired at initial consultation indicating osteophytes at the anterior edge of the distal tibial end and the dorsal side of the talar neck ((a) white arrow, (b) black arrow).
CRIOR2017-2865971.001.jpg
PMC5451781_01_CRIOR2017-2865971.001.jpg
fig1
A plain radiograph and three-dimensional computed tomography scan demonstrated osteophytes at the anterior edge of the distal end of the tibia and dorsal talar neck, indicating anterior ankle impingement syndrome (Figures 1(a) and 1(b)).
Photographs taken during ankle arthroscopy showing (a) large osteophytes at the anterior edge of the distal tibial end (arrow). (b) After excision using a bone cutter (arrow).
CRIOR2017-2865971.002.jpg
PMC5451781_01_CRIOR2017-2865971.002.jpg
fig2
Ankle arthroscopy revealed large osteophytes at the anterior edge of the distal end of the tibia and the dorsal talar neck (Figure 2(a)), which were excised using a bone cutter (Figure 2(b)).
(a) A plain radiograph and (b) a three-dimensional computed tomography scan after ankle arthroscopy showing resection of osteophytes at the anterior edge of the distal tibial end and at the dorsal talar neck ((a) white arrow, (b) black arrow).
CRIOR2017-2865971.003.jpg
PMC5451781_01_CRIOR2017-2865971.003.jpg
fig3
Resection of the osteophytes was confirmed after ankle arthroscopy by plain radiography and three-dimensional computed tomography (Figures 3(a) and 3(b)).
Photograph of the ankle and foot showing swelling between the anteromedial portal and the anterolateral portal (arrow) 3 days after ankle arthroscopy.
CRIOR2017-2865971.004.jpg
PMC5451781_01_CRIOR2017-2865971.004.jpg
fig4
Later that day, the patient presented with pain and swelling in the anterior aspect of the ankle (Figure 4), which he considered to be bearable.
Magnetic resonance images showing a pseudoaneurysm 25 x 22 x 13 mm in size arising from the anterior tibial artery (arrow) at the level of the ankle joint. The pseudoaneurysm is seen as a mass with a heterogeneous (a) low-intensity to isointensity signal on T2-weighted imaging and (b) high-intensity signal on T2 star-weighted imaging.
CRIOR2017-2865971.005.jpg
PMC5451781_01_CRIOR2017-2865971.005.jpg
fig5
Color and duplex Doppler ultrasonography showing flow through the anterior tibial artery (black arrow) at the anterior ankle joint, with decreased flow through the dorsalis pedis artery, suggesting a pseudoaneurysm (white arrow) leaking into the ankle joint (black arrow head). Flow towards and away from the transducer is indicated by red and blue, respectively.
CRIOR2017-2865971.006.jpg
PMC5451781_01_CRIOR2017-2865971.006.jpg
fig6
It showed a mosaic pattern of colors with the "whirling blood flow" and "to-and-fro" motion typical of a pseudoaneurysm on the posterior wall of the distal portion of the anterior tibial artery (Figure 6).
Angiographic image showing a pseudoaneurysm originating from the anterior tibial artery and passing on the anterior side of the ankle joint. Predominantly anterograde filling from the anterior tibial artery is seen (arrow). Flow from the posterior tibial artery and the plantar collateral was also detected. The dorsalis pedis artery is filled by a plantar arch.
CRIOR2017-2865971.007.jpg
PMC5451781_01_CRIOR2017-2865971.007.jpg
fig7
It revealed a pseudoaneurysm with an intact posterior tibial artery and plantar arch circulation (Figure 7).
Photographic images taken during repair of the anterior tibial artery injury demonstrated that the pseudoaneurysm was caused by disruption of the posterior third of the anterior tibial artery wall (arrow) on the anterior side of the ankle joint (a). The injured anterior tibial artery wall was repaired using an end-to-end anastomosis longitudinally (arrow head), without compromising the blood supply to the foot (b).
CRIOR2017-2865971.008.jpg
PMC5451781_01_CRIOR2017-2865971.008.jpg
fig8
The pseudoaneurysm was believed to be caused by disruption of the posterior 1/3 of the anterior tibial artery wall (Figure 8(a)) and leakage of blood into the ankle, forming a pseudoaneurysm. The injured arterial walls facing each other were sutured longitudinally with preservation of blood flow distally, although the diameter of the artery became narrower at this point (Figure 8(b)).