Radial artery pseudoaneurysm: a rare complication after arthroscopic treatment of a volar wrist ganglion in a hemophilia patient

Enormous Articular Hemorrhage Following Arthroscopy, Total Joint Replacement and other Surgical Operations in Hemophilic Patients due to Arterial Pseudoaneurysms: Diagnosis and Treatment

Pseudoaneurysms in hemophilic patients are unusual. We must have a suspicion when the patient has suffered an arterial trauma (following arthroscopy, total joint replacement and other surgical operations). Pseudoaneurysms may take place in any anatomical zone where there has been trauma. The diagnosis must be verified by duplex ultrasonography (US), standard angiogram, computed tomography angiogram or magnetic resonance angiography. There are diverse alternatives for the management of arterial pseudoaneurysms. Small pseudoaneurysms can be solved with conservative noninterventional management. It includes outside pressing, US probe pressing or US-guided thrombin injections. In larger pseudoaneurysms, endovascular methods, such as coil embolization, are now preferred. If the aforesaid methods are unsuccessful, standard surgical management with simple ligation or arterial reconstruction must be carried out. We must suspect a pseudoaneurysm when, following an arterial trauma, there is severe bleeding that does not stop with appropriate management with intravenous injection of the insufficient coagulation factor. The diagnosis has to be verified by imaging. Endovascular methods, such as coil embolization, are now preferred by the majority of physicians. The diagnosis and managment of an arterial pseudoaneurysm must be carried promptly to avert adverse events.

Complications of Wrist Arthroscopy: A Multicenter Study Based on 10,107 Arthroscopies

Background Wrist arthroscopy is now a routine procedure, regarded as safe. Complications are reported in the literature as being rare and mostly minor. Purpose The two goals of this study were to evaluate the incidence and nature of complications based on a very large multicenter retrospective study, and to investigate about a potential learning curve. Methods The authors sent a detailed questionnaire to all members of the European Wrist Arthroscopy Society (EWAS), inquiring about the number and types of complications encountered during their practice of wrist arthroscopy, and about their experience with the technique. Results A total of 36 series comprising 10,107 wrist arthroscopies were included in the study. There were 605 complications (5.98% of the cases), of which 5.07% were listed as serious and 0.91% as minor. The most frequent ones were failure to achieve the procedure (1.16%), and nerve lesions (1.17%). Cartilage lesions and complex regional pain syndrome each occurred in 0.50% cases. Other complications (wrist stiffness, loose bodies, hematomas, tendon lacerations) were less frequent. Breaking down of the data according to each surgeon's experience of the technique showed a significant relationship with the rate of complications, the threshold for a lower complication rate being approximately 25 arthroscopies a year and/or greater than 5 years of experience. Conclusion Although the global incidence of complications was in keeping with the literature, the incidence of serious complications was much higher than previously reported. There is a significant learning curve with the technique of wrist arthroscopy, both in terms of volume and experience.

[Pseudoaneurysm of the radial artery in the hand]

Over 1,400,000 cases of hand trauma are identified each year in France, with a large proportion with open wounds, accounting for significant activity in orthopedic surgery emergency units. It is customary to focus on nerve or tendon injuries as a priority. However, even partial vascular lesions may be complicated by a false aneurysm. We report the case of a false aneurysm of the palmar branch of the radial artery in 25-year-old man, 6 months after a non-treated puncture wound of the thenar eminence. Surgery was undertaken because of increased volume and discomfort on gripping. The surgical procedure consisted of resection and arterial ligature, after a positive preoperative Allen test. Hand aneurysms require an individualized therapeutic procedure. Origins may be diverse; the palmar digital location requires complex treatment. Compensation via a collateral arterial network is required for the vascular steal following ligation and resection. Careful exploration is needed to ensure appropriate compensation. Otherwise, a revascularization procedure must be considered. Some authors propose new less invasive treatments as an alternative to surgery. Even though surgery is relatively simple, the best means of prevention still remains a systematic exploration of vascular elements in case of a hand wound.