Pseudoaneurysms of the Lower Extremity Vessels as a Complication of Hereditary Exostose Chondrodysplasia in Adolescents (Two Case Reports)

Abstract

The article describes two clinical cases of vascular complications related to hereditary exostose chondrodysplasia of the lower limbs in children. Despite early diagnostics the newgrowth was not timely removed. The anatomical localization of the exostoses in the vicinity of the main arterial trunks resulted in formation of pseudo-aneurysms due to a prolonged exposure of the vascular wall to the actively growing bone formations. After diagnostic imaging (ultrasonography and Doppler sonography, CT angiography, MR angiography of the vessels in the lower extremities) the authors performed a simultaneous resection of the femoral artery aneurysm with autovenous grafting and total resection of exostoses in both cases. Late follow up of both patients demonstrated vascular permeability at the graft site and no symptoms of stenosis were observed.

Keywords

exostose chondrodysplasia / femoral artery pseudoaneurysm / children

References

[1] 1. Волков М.В. Болезни костей у детей. М. : Медицина, 1974. с. 139-141.

[2] 2. Юкина Г.П. Изменения в тазобедренных суставах при экзостозной хондродисплазии. Ортопедия, травматология и протезирование. 1971;(6):47-49.

[3] 3. Зацепин С.Т. Костная патология взрослых. М : Медицина; 2001. с. 226-233.

[4] 4. Jaffe H.L. Tumors and tumorous conditions of the bones and joints. Philadelphia : Lea & Febiger; 1958. р. 143-168.

[5] 5. Lichtenstein L., Bernstein D. Unusual benign and malignant chondroid tumors of bone. A survey of some mesenchymal cartilage tumors and malignant chondroblastic

[6] tumors, including a few multicentric ones, as well as many atypical benign chondroblastomas and chondromyxoid fibromas. Cancer.1959;12:1142-1157.

[7] doi: 10.1002/1097-0142(195911/12)12:63.0.co;2-d

[8] 6. Safary A., Limlosch J., Baillon J. [Exostosing disease. One case report. Review of the literature]. Acta Orthop Belg. 1978;44(4):485-495. (In French).

[9] 7. Stickens D., Broun D., Evans G.A. EX T genes are differentially expressed in bones and cartilage during mouse embryogenesis. Dev Dyn. 2000. 218(3):452-464. doi: 10.1002/1097-0177(200007)218:33.0.CO ;2-P.

[10] 8. Trivedi H., Link T.M., O’Donnell R.J., Horvai A.E., Motamedi D. Multiple hereditary exostoses: A pseudoaneurysm masquerading as tumor. Radiology Case. 2016;10(8):50-59. doi: 10.3941/jrcr.v10i8.2849.

[11] 9. Onan B., Onan I.S., Guner Y., Yeniterzi M. Peroneal nerve palsy caused by popliteal pseudoaneurysm in a child with hereditary multiple exostosis. Ann Vasc Surg. 2014;28(4): 1037.e5-9. doi: 10.1016/j.avsg.2013.08.018.

[12] 10. Vasseur M.A., Fabre O. Vascular complications of osteochondromas. J Vasc Surg. 2000;31(3):532-538.

[13] 11. Boyacioğlu K., Kayalar N., Sarioğlu S., Yildizhan I., Mert B., Erentuğ V. Popliteal artery pseudoaneurysm associated with solitary osteochondromatosis. Vascular. 2014;22(4):286-289. doi: 10.1177/1708538113486784.

[14] 12. Pellenc Q., Capdevila C., Julia P., Fabiani J.N. Ruptured popliteal artery pseudoaneurysm complicating a femoral osteochondroma in young patient. J Vasc Surg. 2012;55(4):1164-1165. doi: 10.1016/j.jvs.2011.01.060.

[15] 13. Malhotra A., Moolchand S., Goel H.K., Yadav B.S. Superficial femoral artery pseudo aneurysm: A rare vascular complication of exostoses. Ind J Thorac Cardiovasc Surg. 2009;25:205-207.

[16] 14. Raherinantenaina F., Rakoto-Ratsimba H.N., Rajaonanahary T.M. Management of extremity arterial pseudoaneurysms associated with osteochondromas. Vascular. 2016;24(6):628-637. doi: 10.1177/1708538116634532.