Anterior Tibial Artery Pseudoaneurysm Following Tibial Nailing: A Rare Vascular Complication Managed With Coil Embolization

Introduction: Intramedullary nailing is a widely accepted and effective treatment for tibial shaft fractures. Anterior tibial artery (ATA) pseudoaneurysms caused by interlocking screws are exceedingly uncommon, with only a few cases reported in the literature. Case Report: We present the case of a 56-year-old male who developed worsening swelling and pain in his left lower extremity 8 months after undergoing intramedullary nailing for a tibial shaft fracture. Doppler ultrasound revealed an ATA pseudoaneurysm with characteristic imaging findings, which was confirmed by computed tomography angiography (CTA). The patient was treated with coil embolization of the ATA pseudoaneurysm, followed by surgical evacuation of the thrombus. The post-operative course was uncomplicated, and the patient recovered well. ATA pseudoaneurysm related to tibial nailing can be easily overlooked due to expected post-operative edema and swelling. Early detection through Doppler ultrasound and CTA is essential. Treatment options range from non-invasive methods to open surgery and endovascular interventions. In this case, a combination of coil embolization and surgical hematoma evacuation proved to be a minimally invasive and effective approach. Conclusion: This case highlights the importance of considering rare vascular complications after tibial nailing. Timely diagnosis and endovascular treatment approaches can lead to successful outcomes. Keywords: Tibial fracture, tibia nailing, interlocking screw, pseudoaneurysm, coil embolization.