Vol.:(0123456789) 1 3 European Journal of Orthopaedic Surgery & Traumatology https://doi.org/10.1007/s00590-018-2324-6 ORIGINAL ARTICLE • ANKLE - ARTHROSCOPY Pseudoaneurysm following ankle arthroscopy: a systematic review of case series Kaissar Yammine 1,2  · Nadim Kheir 1  · Jimmy Daher 1  · Joseph Naoum 3  · Chahine Assi 1 Received: 31 July 2018 / Accepted: 22 October 2018 © Springer-Verlag France SAS, part of Springer Nature 2018 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 com- plication 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 fbular 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 afection 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 afect injury healing and consequently PA formation. PA diagnosis should be raised whenever a non-resolving or pulsatile swelling over a portal incision is observed. Keywords Ankle arthroscopy · Artery injury · Anterior tibial artery · Dorsalis pedis artery · Pseudoaneurysm Introduction Most pseudoaneurysms (PA) are iatrogenic usually resulting from vascular interventions, while some could result follow- ing joint arthroscopy [1]. Most PA cases have involved the popliteal vessels after knee arthroscopy [1]. Since its frst description by Takagi in 1939 [2], ankle arthroscopy (AA) has become an important diagnostic and therapeutic tool for the treatment of diferent ankle and subtalar conditions [3]. Iatrogenic complications following AA procedures have been reported to range from 9 [4] to 17% [5] with nerve injuries being the commonest. Though rare, vascular inju- ries after AA are occasionally published with an incidence estimated at 0.008% [3]. Most case reports stated PA as the most frequent vascular complication where the distal branch of the anterior tibial artery (d-ATA), or its terminal branch, the dorsalis pedis artery (DPA), was the most commonly involved (Table 1). Neurovascular complications following AA are thought to be related to the placement of the portals, instrumenta- tion or the procedure type [6, 7]. A recent meta-analysis by Yammine et al. [6] found that the anterocentral portal (AC), as opposed to other ankle portals, was associated with a signifcant higher risk of nerve and vessel inju- ries and missed injuries during arthroscopic simulation on cadavers. The DPA was found to be at a mean distance * Kaissar Yammine cesaryam@gmail.com 1 Orthopedic Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafeh, Lebanon 2 Center for Evidence-Based Anatomy Sports and Orthopedic Research, Beirut, Lebanon 3 Vascular Department, Lebanese American University Medical Center-Rizk Hospital, Achrafeh, Lebanon