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Pseudoaneurysm following ankle arthroscopy: a systematic review of case series

  • Original Article • ANKLE - ARTHROSCOPY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background/objective

Pseudoaneurysms (PA) are rare complications following ankle arthroscopy (AA). Delay in diagnosis is reported to be frequent and could lead to serious complications. Evidence synthesis on the clinical context of such complication lacks in the literature.

Methods

A systematic review is conducted to locate all relevant papers. In total, 23 case reports were included in the review. Data of 23 patients with a mean of 40.9 ± 10.3 years were extracted and analyzed. Outcomes included comorbidities, portals and procedure types performed during AA, PA location and size, time to diagnosis and treatment, and therapeutic modalities.

Results

The results showed that d-ATA and the dorsal pedis artery (DPA) were involved in 18 and 4 cases, respectively. A single case of PA of the fibular artery was described. The mean PA size was found to be 4.2 × 3.9 × 2.1 cm. Five of the 14 patients (35.7%) with a reported detailed medical history were treated for a cardiovascular or hemostasis condition. Delay in PA diagnosis was found to be at a mean time of 50.45 ± 74.6 days. The most commonly reported surgical indications were anterior synovectomy and removal of anterior osteophytes. Ligation was the most common procedure in treating PA.

Conclusion

While portal placement might be a minor factor, the variability of the d-ATA and/or DPA anatomical position and its affection with foot position and distraction during AA could play a role in the arterial injury. Synovectomy and removal of anterior, particularly big-sized, osteophytes could be considered as risk factors as well. A state of hypocoagulability might affect injury healing and consequently PA formation. PA diagnosis should be raised whenever a non-resolving or pulsatile swelling over a portal incision is observed.

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Authors and Affiliations

  1. Orthopedic Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon

    Kaissar Yammine, Nadim Kheir, Jimmy Daher & Chahine Assi

  2. Center for Evidence-Based Anatomy Sports and Orthopedic Research, Beirut, Lebanon

    Kaissar Yammine

  3. Vascular Department, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Lebanon

    Joseph Naoum

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Yammine, K., Kheir, N., Daher, J. et al. Pseudoaneurysm following ankle arthroscopy: a systematic review of case series. Eur J Orthop Surg Traumatol 29, 689–696 (2019). https://doi.org/10.1007/s00590-018-2324-6

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