Pseudoaneurysm of the anterior tibial artery after ankle arthroscopy treated with ultrasound-guided compression therapy. A case report

Most pseudoaneurysms forming after arthroscopic surgery have involved the popliteal vessels after knee arthroscopy1,2. However, the cases of five patients who had a pseudoaneurysm of the anterior tibial artery after ankle arthroscopy have been reported in the English-language literature and were found after a search of the PubMed database with use of three keywords: pseudoaneurysm, ankle, and arthroscopy1,3-6. Although the cases of two patients involved anticoagulation therapy5 and hemophilia3, which increase the risk of arterial injury, iatrogenic trauma may have occurred during portal placement or operative procedures, such as synovectomy and osteophyte resection. All five patients described in the literature were treated by different surgical techniques. We present the case of a patient who had delayed detection of an anterior tibial artery pseudoaneurysm with osseous erosion after ankle arthroscopy. The condition was treated effectively with ultrasound-guided compression therapy. The patient was informed that data concerning the case would be submitted for publication, and he consented. A twenty-five-year-old man, in good general health, presented with a four-year history of pain and swelling in the anterolateral aspect of the right ankle. In addition, the ankle had sustained recurrent plantar flexion and inversion sprains that had been treated conservatively with rest, compression, and intermittent splinting. Physical examination revealed tenderness and moderate swelling of the anterolateral aspect of the right ankle with a positive anteromedial rotatory drawer maneuver7. Stress radiographs demonstrated a positive anterior drawer sign, and magnetic resonance imaging showed increased signal intensity in the anterior talofibular ligament and anterolateral synovitis of the right ankle. The patient underwent ankle arthroscopy with a 4.0-mm, 30° arthroscope with use of standard anteromedial and anterolateral portals under tourniquet control and noninvasive distraction of up to 20 lb (9 kg) with an …