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

Abstract

Pseudoaneurysms in hemophilic patients are unusual. We must have a suspicion when the patient has sufferedan arterial trauma (following arthroscopy, total joint replacement and other surgical operations). Pseudoaneurysmsmay take place in any anatomical zone where there has been trauma. The diagnosis must be verified by duplexultrasonography (US), standard angiogram, computed tomography angiogram or magnetic resonance angiography.There are diverse alternatives for the management of arterial pseudoaneurysms. Small pseudoaneurysms can beresolved with conservative noninterventional management. It includes outside pressing, US probe pressing or USguidedthrombin injections. In larger pseudoaneurysms, endovascular methods, such as coil embolization, are nowpreferred. If the aforesaid methods are unsuccessful, standard surgical management with simple ligation or arterialreconstruction must be carried out. We must suspect a pseudoaneurysm when, following an arterial trauma, thereis severe bleeding that does not stop with appropriate management with intravenous injection of the insufficientcoagulation factor. The diagnosis has to be verified by imaging. Endovascular tmethods, such as coil embolization, arenow preferred by the majority of physicians. The diagnosis and managment of an arterial pseudoaneurysm must becarried promptly to avert adverse events.Level of evidence: III