Yammine Kaissar, Kheir Nadim, Daher Jimmy, Naoum Joseph, Assi Chahine
Orthopedic Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.
Center for Evidence-Based Anatomy Sports and Orthopedic Research, Beirut, Lebanon.
Eur J Orthop Surg Traumatol. 2019 Apr;29(3):689-696. doi: 10.1007/s00590-018-2324-6. Epub 2018 Oct 25.
BACKGROUND/OBJECTIVE: Pseudoaneurysms (PA) are rare complications following ankle arthroscopy (AA). Delay in diagnosis is reported to be frequent and could lead to serious complications. Evidence synthesis on the clinical context of such complication lacks in the literature.
A systematic review is conducted to locate all relevant papers. In total, 23 case reports were included in the review. Data of 23 patients with a mean of 40.9 ± 10.3 years were extracted and analyzed. Outcomes included comorbidities, portals and procedure types performed during AA, PA location and size, time to diagnosis and treatment, and therapeutic modalities.
The results showed that d-ATA and the dorsal pedis artery (DPA) were involved in 18 and 4 cases, respectively. A single case of PA of the fibular artery was described. The mean PA size was found to be 4.2 × 3.9 × 2.1 cm. Five of the 14 patients (35.7%) with a reported detailed medical history were treated for a cardiovascular or hemostasis condition. Delay in PA diagnosis was found to be at a mean time of 50.45 ± 74.6 days. The most commonly reported surgical indications were anterior synovectomy and removal of anterior osteophytes. Ligation was the most common procedure in treating PA.
While portal placement might be a minor factor, the variability of the d-ATA and/or DPA anatomical position and its affection with foot position and distraction during AA could play a role in the arterial injury. Synovectomy and removal of anterior, particularly big-sized, osteophytes could be considered as risk factors as well. A state of hypocoagulability might affect injury healing and consequently PA formation. PA diagnosis should be raised whenever a non-resolving or pulsatile swelling over a portal incision is observed.
背景/目的：假性动脉瘤（PA）是踝关节镜检查（AA）后罕见的并发症。据报道，诊断延迟很常见，可能导致严重并发症。文献中缺乏关于此类并发症临床背景的证据综合。
进行系统综述以查找所有相关论文。该综述共纳入23例病例报告。提取并分析了23例患者的数据，患者平均年龄为40.9±10.3岁。结果包括合并症、AA期间的切口位置和手术类型、PA的位置和大小、诊断和治疗时间以及治疗方式。
结果显示，分别有18例和4例累及胫前动脉（d-ATA）和足背动脉（DPA）。描述了1例腓动脉假性动脉瘤。发现PA的平均大小为4.2×3.9×2.1厘米。在14例有详细病史报告的患者中，有5例（35.7%）因心血管或止血疾病接受治疗。发现PA诊断延迟的平均时间为50.45±74.6天。最常报告的手术指征是前侧滑膜切除术和切除前侧骨赘。结扎是治疗PA最常见的手术方式。
虽然切口位置可能是一个次要因素，但d-ATA和/或DPA解剖位置的变异性及其在AA期间受足部位置和牵引的影响可能在动脉损伤中起作用。滑膜切除术和切除前侧尤其是大尺寸的骨赘也可被视为危险因素。低凝状态可能影响损伤愈合，进而影响PA的形成。每当在切口处观察到持续性或搏动性肿胀时，应考虑PA的诊断。
