Cardiovascular Surgery, Vol. 6, No. 6, pp. 604–606, 1998  1998 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd All rights reserved. Printed in Great Britain 0967–2109/98 $19.00 + 0.00 PII: S0967-2109(98)00087-8 Anterior tibial artery pseudoaneurysm after ankle arthroscopy C. J. Salgado*, D. Mukherjee†, M. A. Quist‡ and S. Cero§ *Department of General/Plastic Surgery Georgetown University Medical Center, Washington, DC, USA and †Attending Vascular Surgeon Inova Fairfax Hospital, Virginia, USA and ‡Northern Virginia Pediatric Medicine Group, Virginia, USA and §Georgetown University Medical Center, Washington, DC, USA Arthroscopy of the ankle has dramatically expanded its role in diagnostic and therapeutic value afforded to the patient; however, it is not without complications. Although the majority of the complications described are neurological in origin, vascular injuries can occur. A case of a patient with normal coagulation parameters who underwent a purely diagnostic ankle arthros- copy and later developed a pseudoaneurysm of her distal anterior tibial artery is described. The pseudoaneurysm was resected without complications and early postoperative recovery has been uneventful.  1998 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved Keywords: anterior tibial artery pseudoaneurysm; ankle arthroscopy The role of arthroscopy in the diagnosis and treat- ment of pathology of the ankle joint has dramatically increased since its earliest description by Takagi in 1939 [1]. By allowing direct visualization of all intra- capsular structures, open ankle arthrotomy can be avoided for certain disorders of the ankle, which leads to less morbidity and rapid rehabilitation. These entities include, but are not limited to, soft- tissue injury, articular injury, osteochondral lesions, unexplained pain or swelling, synovitis and arthrod- esis procedures. Although there is less potential for complications when compared with open arthro- tomy, the risk remains. The majority of compli- cations are neurological in origin and typically corre- spond to portal entry and placement. Other complications that can occur are infection, adhesions, fractures, ligamentous injury and vascular injury [2, 3]. Pseudoaneurysm of the anterior tibial artery has been recently described making this the second reported case of this potential complication after ankle arthroscopy [4]. Correspondence to: Dipankar Mukherjee, MD, FACS, 3301 Wood- burn Road, Room 210, Annandale, VA 22003, USA CARDIOVASCULAR SURGERY DECEMBER 1998 VOL 6 NO 6 604 Case report A 12-year-old girl initially presented after 5 months of chronic left ankle pain subsequent to an injury that was incurred during ballet training. The pain was refractory to both her discontinuation of dancing en pointe and non-steroidal anti-inflammatory medi- cations. Radiographs were normal and magnetic res- onance imaging of her ankle was also normal except for a small localized fluid collection posterior to the talus possibly extending from the tibiotalar joint. Using an anteromedial and anterolateral approach, a diagnostic ankle arthroscopy was perfor- med, which revealed no significant pathology except for a benign effusion. Several weeks after surgery, the patient’s pain and swelling persisted. Two months later as the swelling subsided a pulsatile mass at the level of the ankle became increasingly obvious. Duplex ultrasonography demonstrated a 2-cm pseudoaneurysm over the left distal anterior tibial artery. A left femoral arteriogram with run-off was performed to ensure visualization of an adequate pedal arch with contribution from the posterior tibial and peroneal artery (Figure 1). The pseudoaneurysm of the distal anterior tibial artery measured 2–2.5 cm