Endovascular Repair after End-to-End Anastomosis for Better Outcome: A Case Report

Abstract: Arterial rupture is a surgical emergency that requires immediate treatment. The anterior tibial artery is the main arterial supply of the legs anterior compartment. Tibial artery rupture is a tear or rupture of the tibial artery mostly caused by vascular trauma. We reported a 54-year-old male referred to Prof. Dr. R. D. Kandou hospital with the main complaint of injury and pain in the left lower limb due to being hit by a grass cutter. On physical examination of the lateral side of left cruris region, an open wound with flat edges and muscle base appeared. The hard sign in this case was active hemorrhage and the soft sign was history of hemorrhage at the scene of the injury. During the operation, total anterior tibial artery rupture was identified with a gap less than 2 centimeters. Therefore, end-to-end anastomosis was initially performed for the 2 cm arterial gap, however, Doppler ultrasound revealed inadequate distal blood flow. Endovascular repair with drug-eluting balloon angioplasty restored good distal blood flow. Comprehensive evaluation guides optimal intervention. In conclusion, trauma to the vascular system can be devastating. In this case, there was a total anterior tibial artery rupture due to penetrating trauma. While surgery remains vital, endovascular techniques offer effective alternatives, particularly in cases of distal ischemia and minimal reconstruction needs. Keywords: total anterior tibial artery rupture; penetrating trauma; vascular trauma