Tibial artery pseudoaneurysms: delayed complication of balloon catheter embolectomy.

Although complications of balloon catheter embolectomy are infrequent, the injury potential of these catheters is well recognized. This article describes a case of multiple tibial artery pseudoaneurysms that appeared 4 years after embolectomy in a 42-year-old man with otherwise normal arteries. The patient was treated by internal aneurysmorrhaphy without sequelae. A literature review of balloon catheter injuries yielded 46 cases categorized as arterial disruption (29), intimal injury (12), or catheter malfunction (5). These resulted in hemorrhage (13 cases), arteriovenous fistula (12), pseudoaneurysm (four), thrombosis (three), dissection (five), accelerated atherosclerosis (four), and catheter fragment embolism (five). Of these complications, only 41% were recognized during the initial operation. Direct observation detected 32% of these, whereas 68% were shown only by completion arteriography. Complications recognized during initial operation were more frequently asymptomatic without further surgery (84%) than those detected postoperatively (30%, p less than 0.001). Completion arteriography detected 87% of balloon catheter complications compared with only 23% of complications recognized intraoperatively without arteriography (p less than 0.001). We conclude that delicate technique, completion arteriography, prompt surgical treatment, and extended follow-up are important components of balloon catheter embolectomy.