advanced over a guide wire into the injured genicular artery. The pseudoaneurysm was embolized with two small (2 mm in diameter, 20 mm in length) fibered platinum coils (Cook Europe, Bjaeverskov, Denmark). Follow-up angiography demonstrated complete occlusion of the AV fistula, with no filling of the pseudoaneurysm (Fig. 2). Clinically, the patient became free of symptoms a few days after the embolization and further clinical follow- up at six months was uneventful. DISCUSSION Vascular injuries arising from artroscopy of the knee are very rare, and several large series have reported an incidence of less than 1% (1, 2). Most vascular injuries involve the popliteal artery or vein, or both (2). Pseudoaneurysms of the popliteal and lateral genicular arteries after knee surgery are rare and only a few, isolated case reports have been published (3 6). Pseudoaneurysms are more likely to form when a vessel is incompletely divided and blood dissects into the surrounding soft tissues. The susceptibility of the popliteal artery and its branches to injury during arthroscopic meniscectomy is due to several factors, including the employed surgical technique, and the operator’s experience and knowledge of their anatomic location (3, 4). The popliteal artery is close to the posterior capsule of the joint and it is moved forward during knee flexion. However, visualization of this region during knee arthroscopy is limited and any injury is often not immedi- ately recognized (4). Nevertheless, the formation of combined pseudoa- neurysm and AV fistula after knee arthorscopy is Puig et al. extremely rare. Only two such cases have been previously reported on, and both of these occurred in the popliteal artery (5, 6). Karkos et al. reported a case of AV fistula of the lateral superior and inferior geniculate arteries, and the etiology of this was unclear (7). In our case, the mechanism to injury was probably direct trauma by cutting all three layers of both the artery and vein with scissors, which resulted in an AV fistula. Alternatively, hematoma formation around the artery and vein with degradation of the enclosed vessels may have also resulted in a combined pseudoaneurysm with AV fistula. When a patient has popliteal swelling, mass, bruit, thrill, recurrent hemarthosis, pain, calf edema, and/or a neurologic deficit after a knee arthroscopy, the possibility of a vascular injury should be considered early on in the diagnostic process (2, 4). The diagnosis can be confirmed by conventional arteriography, as in our case, by Color Doppler sonography, or with using three-dimensional CT or MRI arteriography techniques (4 8). Surgical exploration with vessel ligation is the “gold standard” of treatment because it preserves distal flow if collateral circulation has formed (3, 5 8). Other treatment options include correction of the vascular tear by vascular patch or direct suture (8). Sonographically guided compres- sion to occlude the postcatherterization pseudoaneurysm of the femoral and brachial arteries has been reported on (9). However, with the advances in selective endovascular techniques, percutaneous embolization has been success- fully performed for the management of popliteal pseudoa- neurysms and also for the delayed combined pseudoa- neurysm and AV fistula of the anterior tibial artery after an open tibial fracture (10). In our case, we embolized the Fig. 1. A. Digital subtraction intraarterial angiography reveals a pseudoaneurysm originating from the inferior genicular artery (arrow) with shunting of contrast into the venous system (arrowheads). B. Postembolization digital subtraction intraarterial angiography demonstrating the embolized pseudoaneurysm; note the coils that were used and complete occlusion of the aneurismatic fistula (arrow). A 174 B Korean J Radiol 8(2), April 2007