Pseudoaneurysm of the anterior tibial artery after ankle arthroscopy

The formation of an arterial pseudoaneurysm as a complication of ankle arthroscopy is extremely rare, with a reported incidence of 0.008%. Pseudoaneurysm is especially unlikely after ankle arthroscopy by means of standard anteromedial and anterolateral portals. In this report, we describe a case of a pseudoaneurysm of the anterior tibial artery detected 2 weeks after ankle arthroscopy in a 63-year-old woman. The diagnosis was confirmed with a Doppler ultrasonography scan of the right ankle, after which the patient was referred to an interventional radiologist, who performed an angiogram. Endovascular embolization of the pseudoaneurysm was performed thereafter, and the patient experienced an uneventful recovery after the intervention. The potentially catastrophic sequelae of delayed diagnosis or misdiagnosis of the complication, like hemarthrosis of the ankle and compartment syndrome, are dangerous and must not be underestimated. Therefore, a high degree of suspicion for a pseudoaneurysm should be maintained in the postarthroscopy period when a patient presents with abnormal swelling and pain. Potentially preventative measures include careful dissection while making the portals and preoperative mapping of the vascular structures with a duplex or handheld Doppler.