Update on diagnostic and therapeutic features of peripheral artery pseudoaneurysms following orthopedic and traumatologic surgery

Background and aims

Arterial pseudoaneurysms (PSAs) following orthopedic and traumatologic surgery are rare and most publications on this subject are case reports. No update based on robust data has been published previously. The management of this pathology is not codified. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these iatrogenic vascular injuries.

Methods

Medline and EMBASE were queried for publications using the descriptors «artery pseudoaneurysm» and «orthopedic surgery». Articles referenced were read selectively and this review included 121 articles. Patient demographics, clinical presentations, diagnostic methods and treatment were reviewed.

Results

A total of 131 cases of arterial PSAs was analyzed. There were 82 men with an average age of 50 years old. The commonest clinical presentation was painful swelling (58%). Most patients underwent an arteriography (64%). Arterial injuries were frequently caused by knee arthroplasty (25%) and knee arthroscopy (24%). The most common vascular injuries included geniculate (27%) and popliteal arteries (26%). Surgical (53%) and endovascular (40%) procedures were the commonest therapeutic modalities. Postoperative courses were uneventful in 129 patients (98%).

Conclusion

Geniculate and popliteal artery PSAs are the most frequent vascular complications of orthopedic surgery. They must be evoked when faced with a painful swelling and/or pulsatile mass. Arteriography is an ideal option for confirming the diagnosis. It is often performed with embolization to treat small branches PSAs or with stenting graft for those arising from arterial trunks. Alternatively, surgical ligation or repair was still an option.