Pseudoaneurysm of the inferior medial geniculate artery following primary total knee arthroplasty: delayed presentation with recurrent haemorrhagic episodes

Sharma, Himanshu; Singh, Gurmeet; Cavanagh, S. P.; Kay, D.

doi:10.1007/s00167-005-0639-4

Cited by 34 publications

(22 citation statements)

References 12 publications

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“…4 In this case, percutaneous thrombin injection was an option, but it was excluded because we were unsure of the arteries involved and because of the risk of occluding an impor- If the false aneurysm is large in diameter, evacuation of the aneurysmal cavity and ligation of the feeding vessel or a vein patch can be performed. 10,15 conclusIon Although extremely rare, the possibility of pseudoaneurysm should be considered when patients present with swellings around the knee following TKA. Coil embolization is a relatively noninvasive procedure with good results.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Coil Embolization of Pseudoaneurysm of a Branch of the Anterior Tibial Artery Following Total Knee Replacement

2009

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Section: Discussionmentioning

confidence: 99%

Endovascular Coil Embolization of Pseudoaneurysm of a Branch of the Anterior Tibial Artery Following Total Knee Replacement

2009

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“…2 Imaging the pseudoaneurysm by CT-angiography within 2-3 weeks following the procedure [1,2,9,14]. Some exceptions including delayed diagnoses have also been reported [1,4,15].…”

Section: Discussionmentioning

confidence: 99%

“…The percutaneous angiographic embolization with coils offers the advantages of a minimally invasive approach and may represent an effective and safe alternative to the gold standard of open surgical exploration [1,7,9,12,14,15].…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of a pseudoaneurysm with recurrent hemarthrosis of the knee joint

Burger

Allenberg

Kaufmann

et al. 2008

Knee Surg Sports Traumatol Arthr

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This is a case report of recurrent hemarthrosis of the knee joint over 3 months. The patient, a 47-year-old male had three arthroscopic procedures with multiple joint punctures over a 3-month-period prior to our initial consultation. The first procedure (arthroscopic synovectomy) was done for suspected infection following a series of hyaluronic acid injections. Recurrent hemarthrosis developed subsequent to this. Upon further evaluation, a pseudoaneurysm of the superior middle genicular artery was detected and successfully treated with selective angiographic embolization.

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“…6,8 Because aspiration may not fully resolve a patient's symptoms, further management must be tailored to the potential underlying etiology of the hemarthroses. In the post-TKA setting, arthroscopic 6 and angiographic investigations 11 often reveal a hypertrophic synovium as the underlying mechanism, though other causes have been reported including: arteriovenous fistula of the geniculate vessels, 3 pseudoaneurysm of geniculate vessels, 27 angiosarcoma, 4 impingement of vascular structures under meniscal remnants, 2 and implant malposition. 27 It is pertinent for the surgeon faced with recurrent hemarthroses following TKA to thoroughly consider these various etiologies, as they may guide further management.…”

Section: Clinical Significancementioning

confidence: 99%

Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis

et al. 2019

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Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding this therapy. This meta-analysis aims to assess the rate of symptom relief, the number of embolizations needed to achieve relief, and the rate of complications associated with embolization. Public databases were queried from 1998 until 2018 for TKA-associated recurrent hemarthroses treated with embolization. Eight studies met inclusion and exclusion criteria. Major complications were defined as those requiring readmission or nonelective reoperation; minor complications were defined as those not requiring readmission or reoperation. Pooled statistics were calculated utilizing the method of inverse variance. Fifty-nine patients with a mean follow-up of 30 months (range, 1–50 months) were evaluated. The pooled proportion of patients with symptom improvement following embolization was 86% (95% confidence interval [CI]: 74–93%, I 2: 0%, p = 0.97). The average number of embolization procedures was 1.30 (95% CI: 1.03–1.63, I 2: 0%, p = 0.66). The pooled proportion of patients who required a second embolization procedure was 26% (95% CI: 15–40%, I 2: 0%, p = 0.43), while those requiring three or more procedures was 13% (95% CI: 6–25%, I 2: 0%, p = 0.87). The rate of complications were as follows: any complication – 19% (95% CI: 11–32%, I 2: 0%, p = 0.81); major complications–8% (95% CI: 3–19%, I 2: 0%, p = 0.96); minor complications–18% (95% CI: 10–31%, I 2: 0%, p = 0.79); inguinal hematoma–9% (95% CI: 4–19%, I 2: 0%, p = 1.00); skin necrosis–15% (95% CI: 7–29%, I 2: 0%, p = 0.62); and incision breakdown–7% (95% CI: 3–17%, I 2: 0%, p = 1.00). Previous literature on selective artery embolization following TKA is relatively limited. This meta-analysis supports embolization as a potentially safe and effective treatment for recurrent hemarthroses after TKA. Other correctable causes of recurrent hemarthrosis, such as instability or malalignment, must be diligently ruled out prior to utilizing embolization. Surgeons should be aware of embolization's potential role in the postoperative period following TKA.

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Pseudoaneurysm of the inferior medial geniculate artery following primary total knee arthroplasty: delayed presentation with recurrent haemorrhagic episodes

Cited by 34 publications

References 12 publications

Endovascular Coil Embolization of Pseudoaneurysm of a Branch of the Anterior Tibial Artery Following Total Knee Replacement

Endovascular Coil Embolization of Pseudoaneurysm of a Branch of the Anterior Tibial Artery Following Total Knee Replacement

Delayed diagnosis of a pseudoaneurysm with recurrent hemarthrosis of the knee joint

Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis

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