Abstract
We present a rare case of pseudoaneurysm after ankle arthroscopy that was successfully surgically repaired. A 40-year-old male with a history of synovitis presented to our clinic with a complaint of pulsatile swelling of the right ankle. The patient had undergone arthroscopic synovectomy of the right ankle 8 weeks previously. Clinical examination revealed an indurated, pulsatile mass on the right ankle with painful range of motion and normal sensation and perfusion. An arterial duplex study demonstrated a pseudoaneurysm of the dorsalis pedis artery (Panel A) with normal flow proximal and distal to the neck. The patient underwent intraoperative angiography, which confirmed a 4.5 cm pseudoaneurysm arising from the dorsalis pedis artery (Panel B). Under spinal anesthesia, a longitudinal para-aneurysmal incision was made and the bleeding focus identified along the medial wall of the dorsalis pedis artery. The damaged artery (Panel C, left panel) was clamped proximally and distally with vascular slings, followed by evacuation of the sac and autogenous vein patch angioplasty (Panel C, right panel). Postoperative angiography documented good flow in the dorsalis pedis artery (Panel D). The patient recovered completely and uneventfully. Three months postoperatively he was asymptomatic and wearing normal shoes.
A tentative diagnosis of a pseudoaneurysm may be made by palpation of the pulsatile mass and detection of an associated systolic bruit. Arterial duplex and arteriography can be used to confirm the diagnosis. 1
The use of conservative treatment and endovascular therapy is limited.2–4
Surgical treatment remains the definitive treatment modality in order to prevent possible complications such as rupture, neurologic alteration due to long-standing compression, or motor alterations such as restriction of the dorsiflexion of the foot. 5
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Footnotes
Declaration of conflicting interest
The authors declare that there is no conflict of interest.
Funding
This paper was supported by Wonkwang University in 2013.