Transarterial Embolization of an Inferior Genicular Artery Pseudoaneurysm with Arteriovenous Fistula after Arthroscopy Josep Puig, MD Joan Perendreu, MD Jose Ramo n Fortuno, MD Jordi Branera, MD Joan Falco , MD Index terms: Arteriovenous malformations Interventional procedures Interventional procedures, technology Knee Korean J Radiol 2007;8:173-175 Received January 7, 2006; accepted after revision February 28, 2006. Department of Radiology, Dr. Josep Trueta University Hospital, Av. França s/n, 17007 Girona, Spain Unitat de Diagnostic per la Imatge d’Alta Tecnologia (UDIAT-CD), Corporacio Sanitaria del Parc Tauli, Parc-Tauli s/n, 08208 Sabadell, Spain. Address reprint requests to: J. Puig, MD, Department of Radiology, Dr. Josep Trueta University Hospital, Av. França s/n 17007 Girona, Spain. Tel. +34-972-486020 Fax. +34-972-483085 e-mail: h416ujpu@htrueta.scs.es Korean J Radiol 8(2), April 2007 Arthroscopic meniscectomy of the knee is generally a safe and effective proce- dure with a low rate of vascular complications. We report here on a unique case of a 55-year-old man with a lateral inferior genicular artery pseudoaneurysm and a concomitant arteriovenous fistula that developed after arthroscopic meniscecto- my; this was successfully treated with selective angiographic embolization. This case illustrates the effectiveness of an endovascular approach as a minimally invasive treatment for this uncommon complication that occurs after an arthro- scopic procedure. A procedure. The worldwide clinical experience has proven this technique rthroscopy meniscectomy of the knee has become a routine therapeutic to be safe, effective and well tolerated by patients, with low rates of morbidity and mortality (1, 2). The overall complication rate for knee arthroscopy ranges from 0.56% to 8.2%. Vascular injuries are quite rare and they represent less than 1% of all the complications (1 3), and most have involved the popliteal artery or vein, or both. There are only a few reports about injuries to the genicular artery during arthroscopic procedures. In this report, we describe a unique case of iatrogenic lateral inferior genicular artery pseudoaneurysm and concomitant arteriovenous fistula that were detected one week after arthroscopic meniscectomy; these lesions were successfully treated with superselective percutaneous transarterial embolization. CASE REPORT A 55-year-old man in good general health had pain and intermittent locking of the left knee of two months duration. Clinical examination revealed tenderness at the lateral joint line and moderate effusion. Magnetic resonance imaging (MRI) showed a displaced bucket-handle tear of the lateral meniscus and so arthroscopic lateral meniscectomy was performed. Increasing pain and swelling in the left popliteal fossa developed postoperatively over the following five days. A 65-mL hematoma was aspired and repeat arthroscopy of the knee detected only remnants of blood. The limb showed no signs of ischemia. The same symptomatology was displayed four days later and so the patient was referred for endovascular management. Selective arteriography was performed via the right femoral artery, and a 4-Fr catheter was placed into the left proximal popliteal artery. After contrast injection (30 mL at 8 mL/sec; Iopromida, Shering, Madrid, Spain), a pseudoaneurysm measuring 2.5 1.6 0.9 mm and arising from the lateral inferior genicular artery was detected; there was early venous drainage via the hypertrophied genicular veins, forming an arteriovenous (AV) fistula (Fig. 1). A hydrophilic 3-Fr catheter (Terumo, Leuven, Belgium) was selectively 173