Percutaneous Treatment Pseudo-Aneurism of the Hand in Hemophilic Patient

Pseudo aneurysms of the hand are infrequent lesions, usually associated with perforating trauma. The diagnosis is based on clinical suspicion and image confirmation of a pulsatile swelling. Various treatment modalities are currently described in the literature.

Presentation of a clinical case and discussion of the treatment strategy instituted.

Clinical case: Man, 35 years old, with hemophilia A. History of perforating trauma of the palmar face of the right hand 3 weeks ago, having been sutured in the local hospital. Since then he notices a pulsatile swelling in the palm of the hand associated with paresthesias and decreased sensitivity in the index finger. A pseudo-aneurysm with 2x3cm was observed, partially thrombosed, and with probable origin in the palmar arch or in the common digital artery. He underwent angiography demonstrating the patency of the palmar arch but without perfusion of the pseudo-aneurysm, and the control dupplex scan showed complete thrombosis of the false aneurysm. After 2 months of follow-up, the dupplex scan was repeated and repermeabilization of the pseudo-aneurysm was verified. The patient was then treated with percutaneous Doppler-guided thrombin injection. Immediate thrombosis of the lesion was found, with no evidence of ischemic complications. He remained asymptomatic under clinical surveillance.

For small pseudo-aneurysm conservative non- -interventional treatment with external compression may be effective. Conventional surgical treatment with simple ligation or arterial reconstruction may be indicated in larger pseudo-aneurysm. Recently, endovascular techniques such as coil embolization have also been described. Hemophilia A is a genetic disease of recessive hereditary transmission linked to the X chromosome, with deficiency of factor VIII of the coagulation cascade, which manifests with increased risk of hemorrhage. In this particular case, given the risk of hemorrhage, we chose minimally invasive percutaneous treatment, with clinical and imagological success and no complications. Percutaneous treatment by ecodoppler- guided injection of thrombin is an effective and safe treatment, particularly in pseudo-aneurysm associated with surgical risk factors.