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



Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain


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
resolved with conservative noninterventional management. It includes outside pressing, US probe pressing or USguided
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 tmethods, 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.
Level of evidence: III


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Volume 9, Issue 5
September and October 2021
Pages 475-479
  • Receive Date: 12 March 2020
  • Revise Date: 06 April 2020
  • Accept Date: 06 April 2020
  • First Publish Date: 01 September 2021