Sural arteriovenous fistula after knee joint puncture

膝窩部からの膝関節注射が原因と思われる稀な腓腹動静脈瘻を経験した.症例は72歳の女性.慢性的な左膝窩部痛のため整形外科を受診したところ,膝窩部に拍動性腫瘤を認めたため当科に紹介となった.既往として左変形性膝関節症に対して約30年前に膝窩部から膝関節内注射を受けている.Duplex scanで膝窩部に動静脈瘻が存在し,拍動性腫瘤は動脈瘤化した流出静脈であることが判明した.造影CTと動脈造影で腓腹動脈が責任血管であることが判明したが,流出静脈の確定には至らなかった.治療法は外科的切除を選択した.術中所見から流出静脈が腓腹静脈であることが判明し,腓腹動静脈瘻と確定された.腓腹静脈の瘤化した部分のみを切除し,静脈を温存するように切離断端を長軸方向に縫合閉鎖した後に,流入動脈である腓腹動脈を瘻孔と伴に切離し,その根部をパッチ形成によって閉鎖した.

We experienced the rare sural arteriovenous fistula attributable to intra-articular knee joint injection. A 72-year-old female was referred to our department from the orthopedics clinic with soreness and pulsatile mass around the left popliteal fossa. She received intra-articular injection into left knee joint through popliteal fossa for the gonarthrosis approximately 30 years ago. Arteriovenous fistula was diagnosed by duplex scan, and it was proved that the pulsatile mass was a venous aneurysm. Enhanced computed tomography and angiography showed an arteriovenous fistula arising from the left sural artery, but did not reveal the drainage vein. The surgical resection with posterior approach was chosen. An arteriovenous fistula between sural artery and vein, and a large venous aneurysm arising from sural vein at the level of the arteriovenous communication were proved during surgery. The sural venous aneurysm was resected and directly repaired. The sural artery including a fistula was dissected and its orifice was closed by patch angioplasty.

腓腹動静脈瘻

関節穿刺

外科的切除