Persisterende zwelling na enkelartroscopie: pseudoaneurysma van de arteria tibialis anterior als zeldzame complicatie

Abstract

Persistent swelling after ankle arthroscopy: pseudoaneurysm of the anterior tibial artery as a rare complication A patient was admitted to a geriatric rehabilitation ward following a septic arthritis for which she received an antibiotic treatment and arthroscopic irrigation. She had a normal kidney function and received a prophylactic dose of enoxaparin for the prevention of a deep venous thrombosis (DVT). During the hospitalization, a progressive, painless swelling of the ankle was seen. The ultrasonography showed a pseudoaneurysm of the anterior tibial artery measuring 4.2 cm by 4 cm by 1.7 cm. Following the surgical consultation, compression therapy was started. The follow-up ultrasonography after 4 weeks showed absence of flow in the pseudoaneurysm. A pseudoaneurysm is a rare complication (0.008%) of foot and ankle surgery. Risk factors are malnutrition, immunosuppression, diabetes mellitus and trauma or infection. Abnormal coagulation may contribute to the development of a pseudoaneurysm. The diagnosis is mostly based on clinical clues, confirmed by means of color-flow Doppler imaging. The treatment options include non-surgical methods (external compression, ultrasound-guided compression and ultrasound-guided thrombin injections), percutaneous endovascular therapy (coil, stenting) or surgical ligation with an aneurysmectomy and an arterial reconstruction. Although pseudoaneurysms are a rare complication, their possibility should be considered in the period following the commencement of mobilization and weight-bearing after ankle surgery, especially if risk factors are present.