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Erschienen in: Skeletal Radiology 5/2019

10.10.2018 | Scientific Article

Pseudoaneurysm after total knee arthroplasty: imaging findings in 7 patients

verfasst von: Steven P. Daniels, Darryl B. Sneag, Jennifer L. Berkowitz, David Trost, Yoshimi Endo

Erschienen in: Skeletal Radiology | Ausgabe 5/2019

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Abstract

Objective

To describe the clinical presentation of arterial pseudoaneurysms following total knee arthroplasty (TKA) and their diagnostic imaging features on ultrasound and magnetic resonance angiography (MRA) in 7 patients.

Materials and methods

A search of our radiology report database from 2007 to 2017 yielded 7 patients with a pseudoaneurysm diagnosed by imaging after TKA. Clinical notes and imaging were reviewed.

Results

All 7 patients were male and ranged in age from 53 to 68 (mean 61) years. All patients presented with a painful swollen knee and hemarthrosis within the first month following surgery. Five patients presented after primary TKA. One patient presented after explantation for septic arthritis and another after partial synovectomy for septic arthritis without explantation. Ultrasound identified the pseudoaneurysm as a hypoechoic or hyperechoic mass with a “yin-yang” appearance of turbulent arterial flow and associated complex joint effusion. On MRA, the pseudoaneurysm was a mass next to a parent artery showing avid contrast enhancement in the arterial phase that persisted into the venous phase and washed out in the late venous phase. Six pseudoaneurysms arose from lateral geniculate arteries and 1 from a medial geniculate artery. There were no popliteal artery pseudoaneurysms. Five patients were treated endovascularly, 1 patient thrombosed without intervention, and 1 patient was treated with open surgery.

Conclusion

Pseudoaneurysm is a potential source of a painful swollen knee with hemarthrosis or a drop in hematocrit after TKA and can be identified with either ultrasound or MRA.
Literatur
1.
Zurück zum Zitat Calligaro KD, Dougherty MJ, Ryan S, Booth RE. Acute arterial complications associated with total hip and knee arthroplasty. J Vasc Surg. 2003;38:1170–7.CrossRefPubMed Calligaro KD, Dougherty MJ, Ryan S, Booth RE. Acute arterial complications associated with total hip and knee arthroplasty. J Vasc Surg. 2003;38:1170–7.CrossRefPubMed
2.
Zurück zum Zitat Calligaro KD, DeLaurentis DA, Booth RE, Rothman RH, Savarese RP, Dougherty MJ. Acute arterial thrombosis associated with total knee arthroplasty. J Vasc Surg. 1994;20:927–30.CrossRefPubMed Calligaro KD, DeLaurentis DA, Booth RE, Rothman RH, Savarese RP, Dougherty MJ. Acute arterial thrombosis associated with total knee arthroplasty. J Vasc Surg. 1994;20:927–30.CrossRefPubMed
3.
Zurück zum Zitat Smith DE, McGraw RW, Taylor DC, Masri BA. Arterial complications and total knee arthroplasty. J Am Acad Orthop Surg. 2001;9:253–7.CrossRefPubMed Smith DE, McGraw RW, Taylor DC, Masri BA. Arterial complications and total knee arthroplasty. J Am Acad Orthop Surg. 2001;9:253–7.CrossRefPubMed
4.
Zurück zum Zitat Holmberg A, Milbrink J, Bergqvist D. Arterial complications after knee arthroplasty: 4 cases and a review of the literature. Acta Orthop Scand. 1996;67:75–8.CrossRefPubMed Holmberg A, Milbrink J, Bergqvist D. Arterial complications after knee arthroplasty: 4 cases and a review of the literature. Acta Orthop Scand. 1996;67:75–8.CrossRefPubMed
5.
Zurück zum Zitat Troutman DA, Dougherty MJ, Spivack AI, Calligaro KD. Updated strategies to treat acute arterial complications associated with total knee and hip arthroplasty. J Vasc Surg. 2013;58:1037–42.CrossRefPubMed Troutman DA, Dougherty MJ, Spivack AI, Calligaro KD. Updated strategies to treat acute arterial complications associated with total knee and hip arthroplasty. J Vasc Surg. 2013;58:1037–42.CrossRefPubMed
6.
Zurück zum Zitat Boutchichi A, Ciornohac J, Daubresse F. Pseudoaneurysm after total knee arthroplasty: a rare complication with different possible clinical presentations. Acta Orthop Belg. 2013;79:16–9.PubMed Boutchichi A, Ciornohac J, Daubresse F. Pseudoaneurysm after total knee arthroplasty: a rare complication with different possible clinical presentations. Acta Orthop Belg. 2013;79:16–9.PubMed
7.
Zurück zum Zitat Ghazala CG, Elsaid TA, Mudawi A. Popliteal artery pseudoaneurysm with secondary chronic common peroneal nerve neuropathy and foot drop after total knee replacement. Ann Vasc Surg. 2015;29:1453.e5–8.CrossRef Ghazala CG, Elsaid TA, Mudawi A. Popliteal artery pseudoaneurysm with secondary chronic common peroneal nerve neuropathy and foot drop after total knee replacement. Ann Vasc Surg. 2015;29:1453.e5–8.CrossRef
8.
Zurück zum Zitat Rukavina A, Kerkhoffs GM, Schneider P, Kuster MS. Recurrent hemarthrosis after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2010;18:898–900.CrossRefPubMedPubMedCentral Rukavina A, Kerkhoffs GM, Schneider P, Kuster MS. Recurrent hemarthrosis after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2010;18:898–900.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Geertsema D, Defoort KC, van Hellemondt GG. Popliteal pseudoaneurysm after total knee arthroplasty: a report of 3 cases. J Arthroplast. 2012;27:1581.e1–4.CrossRef Geertsema D, Defoort KC, van Hellemondt GG. Popliteal pseudoaneurysm after total knee arthroplasty: a report of 3 cases. J Arthroplast. 2012;27:1581.e1–4.CrossRef
10.
Zurück zum Zitat Sharma H, Singh GK, Cavanagh SP, Kay D. Pseudoaneurysm of the inferior medial geniculate artery following primary total knee arthroplasty: delayed presentation with recurrent haemorrhagic episodes. Knee Surg Sports Traumatol Arthrosc. 2006;14:153–5.CrossRefPubMed Sharma H, Singh GK, Cavanagh SP, Kay D. Pseudoaneurysm of the inferior medial geniculate artery following primary total knee arthroplasty: delayed presentation with recurrent haemorrhagic episodes. Knee Surg Sports Traumatol Arthrosc. 2006;14:153–5.CrossRefPubMed
11.
Zurück zum Zitat Noda M, Saegusa Y, Takahashi M, Hirata Y. A case of the geniculate artery pseudoaneurysm after total knee arthroplasty: search for preventive measures by evaluation of arterial anatomy of cadaver knees. Knee Surg Sports Traumatol Arthrosc. 2013;21:2721–4.CrossRefPubMed Noda M, Saegusa Y, Takahashi M, Hirata Y. A case of the geniculate artery pseudoaneurysm after total knee arthroplasty: search for preventive measures by evaluation of arterial anatomy of cadaver knees. Knee Surg Sports Traumatol Arthrosc. 2013;21:2721–4.CrossRefPubMed
12.
Zurück zum Zitat Saini P, Meena S, Malhotra R, Gamanagatti S, Kumar V, Jain V. Pseudoaneurysm of the superior lateral genicular artery: case report of a rare complication after total knee arthroplasty. Patient Saf Surg. 2013;7:15.CrossRefPubMedPubMedCentral Saini P, Meena S, Malhotra R, Gamanagatti S, Kumar V, Jain V. Pseudoaneurysm of the superior lateral genicular artery: case report of a rare complication after total knee arthroplasty. Patient Saf Surg. 2013;7:15.CrossRefPubMedPubMedCentral
13.
14.
Zurück zum Zitat D’Angelo F, Carrafiello GP, Laganà D, et al. Popliteal artery pseudoaneurysm after a revision of total knee arthroplasty: endovascular treatment with a stent graft. Emerg Radiol. 2007;13:323–7.CrossRefPubMed D’Angelo F, Carrafiello GP, Laganà D, et al. Popliteal artery pseudoaneurysm after a revision of total knee arthroplasty: endovascular treatment with a stent graft. Emerg Radiol. 2007;13:323–7.CrossRefPubMed
15.
Zurück zum Zitat Ammori MB, Evans AR, Mclain AD. Popliteal artery pseudoaneurysm after total knee arthroplasty. J Arthroplast. 2016;31:2004–7.CrossRef Ammori MB, Evans AR, Mclain AD. Popliteal artery pseudoaneurysm after total knee arthroplasty. J Arthroplast. 2016;31:2004–7.CrossRef
16.
Zurück zum Zitat Law KY, Cheung KW, Chiu KH, Antonio GE. Pseudoaneurysm of the geniculate artery following total knee arthroplasty: a report of two cases. J Orthop Surg (Hong Kong). 2007;15:386–9.CrossRef Law KY, Cheung KW, Chiu KH, Antonio GE. Pseudoaneurysm of the geniculate artery following total knee arthroplasty: a report of two cases. J Orthop Surg (Hong Kong). 2007;15:386–9.CrossRef
17.
Zurück zum Zitat Pritsch T, Parnes N, Menachem A. A bleeding pseudoaneurysm of the lateral genicular artery after total knee arthroplasty—a case report. Acta Orthop. 2005;76:138–40.CrossRefPubMed Pritsch T, Parnes N, Menachem A. A bleeding pseudoaneurysm of the lateral genicular artery after total knee arthroplasty—a case report. Acta Orthop. 2005;76:138–40.CrossRefPubMed
18.
Zurück zum Zitat Sneag DB, Bogner EA, Potter HG. Magnetic resonance imaging evaluation of the painful total knee arthroplasty. Semin Musculoskelet Radiol. 2015;19:40–8.CrossRefPubMed Sneag DB, Bogner EA, Potter HG. Magnetic resonance imaging evaluation of the painful total knee arthroplasty. Semin Musculoskelet Radiol. 2015;19:40–8.CrossRefPubMed
19.
Zurück zum Zitat Vaidhyanath R, Blanshard KS. Case report: insertion of a covered stent for treatment of a popliteal artery pseudoaneurysm following total knee arthroplasty. Br J Radiol. 2003;76:195–8.CrossRefPubMed Vaidhyanath R, Blanshard KS. Case report: insertion of a covered stent for treatment of a popliteal artery pseudoaneurysm following total knee arthroplasty. Br J Radiol. 2003;76:195–8.CrossRefPubMed
20.
Zurück zum Zitat Shaw A, Stephen A, Lund J, Bungay P, Denunzio M. Geniculate arterial pseudoaneurysm formation following trauma and elective orthopaedic surgery to the knee: 2 case reports and a review of the literature. J Radiol Case Rep. 2009;3:12–6.PubMedPubMedCentral Shaw A, Stephen A, Lund J, Bungay P, Denunzio M. Geniculate arterial pseudoaneurysm formation following trauma and elective orthopaedic surgery to the knee: 2 case reports and a review of the literature. J Radiol Case Rep. 2009;3:12–6.PubMedPubMedCentral
21.
Zurück zum Zitat Kindsfater K, Scott R. Recurrent hemarthrosis after total knee arthroplasty. J Arthroplast. 1995;10(Suppl):S52–5.CrossRef Kindsfater K, Scott R. Recurrent hemarthrosis after total knee arthroplasty. J Arthroplast. 1995;10(Suppl):S52–5.CrossRef
22.
Zurück zum Zitat Oishi CS, Elliott ML, Colwell CW Jr. Recurrent hemarthrosis following a total knee arthroplasty. J Arthroplast. 1995;10(Suppl):S56–8.CrossRef Oishi CS, Elliott ML, Colwell CW Jr. Recurrent hemarthrosis following a total knee arthroplasty. J Arthroplast. 1995;10(Suppl):S56–8.CrossRef
23.
Zurück zum Zitat Hash TW 2nd, Maderazo AB, Haas SB, Saboeiro GR, Trost DW, Potter HG. Magnetic resonance angiography in the management of recurrent hemarthrosis after total knee arthroplasty. J Arthroplast. 2011;26:1357–61.e1.CrossRef Hash TW 2nd, Maderazo AB, Haas SB, Saboeiro GR, Trost DW, Potter HG. Magnetic resonance angiography in the management of recurrent hemarthrosis after total knee arthroplasty. J Arthroplast. 2011;26:1357–61.e1.CrossRef
24.
Zurück zum Zitat Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics. 2005;25:S173–89.CrossRefPubMed Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics. 2005;25:S173–89.CrossRefPubMed
25.
Zurück zum Zitat Mahmoud MZ, Al-Saadi M, Abuderman A, et al. “To-and-fro” waveform in the diagnosis of arterial pseudoaneurysms. World J Radiol. 2015;7:89–99.CrossRefPubMedPubMedCentral Mahmoud MZ, Al-Saadi M, Abuderman A, et al. “To-and-fro” waveform in the diagnosis of arterial pseudoaneurysms. World J Radiol. 2015;7:89–99.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Andreisek G, Pfammatter T, Goepfert K, et al. Peripheral arteries in diabetic patients: standard bolus-chase and time-resolved MR angiography. Radiology. 2007;242:610–20.CrossRefPubMed Andreisek G, Pfammatter T, Goepfert K, et al. Peripheral arteries in diabetic patients: standard bolus-chase and time-resolved MR angiography. Radiology. 2007;242:610–20.CrossRefPubMed
27.
Zurück zum Zitat Murakami AM, Chang A, Foo LF. Traumatic lateral plantar artery pseudoaneurysm and the use of time-resolved MR angiography. HSS J. 2010;6:214–8.CrossRefPubMedPubMedCentral Murakami AM, Chang A, Foo LF. Traumatic lateral plantar artery pseudoaneurysm and the use of time-resolved MR angiography. HSS J. 2010;6:214–8.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Langer S, Krämer N, Mommertz G, et al. Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast-enhanced 3D MRA. J Vasc Surg. 2009;49:1196–202.CrossRefPubMed Langer S, Krämer N, Mommertz G, et al. Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast-enhanced 3D MRA. J Vasc Surg. 2009;49:1196–202.CrossRefPubMed
29.
Zurück zum Zitat Blackham KA, Passalacqua MA, Sandhu GS, Gilkeson RC, Griswold MA, Gulani V. Applications of time-resolved MR angiography. Am J Roentgenol. 2011;196:W613–20.CrossRef Blackham KA, Passalacqua MA, Sandhu GS, Gilkeson RC, Griswold MA, Gulani V. Applications of time-resolved MR angiography. Am J Roentgenol. 2011;196:W613–20.CrossRef
30.
Zurück zum Zitat Gaheer RS, Chirputkar K, Sarungi M. Spontaneous resolution of superior medial geniculate artery pseudoaneurysm following total knee arthroplasty. Knee. 2014;21:586–8.CrossRefPubMed Gaheer RS, Chirputkar K, Sarungi M. Spontaneous resolution of superior medial geniculate artery pseudoaneurysm following total knee arthroplasty. Knee. 2014;21:586–8.CrossRefPubMed
31.
Zurück zum Zitat Julien TP, Gravereaux E, Martin S. Superior medial geniculate artery pseudoaneurysm after primary total knee arthroplasty. J Arthroplast. 2012;27:323.e13–6.CrossRef Julien TP, Gravereaux E, Martin S. Superior medial geniculate artery pseudoaneurysm after primary total knee arthroplasty. J Arthroplast. 2012;27:323.e13–6.CrossRef
32.
Zurück zum Zitat Pai VS. Traumatic aneurysm of the inferior lateral geniculate artery after total knee replacement. J Arthroplast. 1999;14:633–4.CrossRef Pai VS. Traumatic aneurysm of the inferior lateral geniculate artery after total knee replacement. J Arthroplast. 1999;14:633–4.CrossRef
33.
Zurück zum Zitat Butt U, Samuel R, Sahu A, Butt IS, Johnson DS, Turner PG. Arterial injury in total knee arthroplasty. J Arthroplast. 2010;25:1311–8.CrossRef Butt U, Samuel R, Sahu A, Butt IS, Johnson DS, Turner PG. Arterial injury in total knee arthroplasty. J Arthroplast. 2010;25:1311–8.CrossRef
34.
Zurück zum Zitat Ninomiya JT, Dean JC, Goldberg VM. Injury to the popliteal artery and its anatomic location in total knee arthroplasty. J Arthroplast. 1999;14:803–9.CrossRef Ninomiya JT, Dean JC, Goldberg VM. Injury to the popliteal artery and its anatomic location in total knee arthroplasty. J Arthroplast. 1999;14:803–9.CrossRef
Metadaten
Titel
Pseudoaneurysm after total knee arthroplasty: imaging findings in 7 patients
verfasst von
Steven P. Daniels
Darryl B. Sneag
Jennifer L. Berkowitz
David Trost
Yoshimi Endo
Publikationsdatum
10.10.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Skeletal Radiology / Ausgabe 5/2019
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-018-3084-4

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