Endovascular treatment of a pseudoaneurysm in the right inferomedial genicular artery after arthroscopic anterior cruciate ligament reconstruction: a case report

Rupture of the anterior cruciate ligament (ACL) is a common knee injury, and reconstruction via arthroscopy is popular for its safety and low complication rate, around 1%. Vascular injuries from this procedure are extremely rare, with an incidence of 0.003%-1%. Pseudoaneurysms following knee arthroscopy are even less frequent. This paper discusses a rare case of pseudoaneurysm after ACL reconstruction in the articular branch of the right inferomedial genicular artery (IMGA), originating from an anterior tibial artery with a high origin. A 47-year-old man with Von Willebrand disease developed a 24 mm pseudoaneurysm 30 days post-ACL reconstruction. CT-angiography showed the pseudoaneurysm near the tibial tunnel screw and an unusually high anterior tibial artery origin. Emergency angiography confirmed this, and embolization using Squid Peri 18 was successful, with no complications. The patient recovered well. Vascular injury is a rare knee arthroscopy complication, but early diagnosis and awareness of anatomical variations are essential. Endovascular treatment for iatrogenic pseudoaneurysms is safe and effective and facilitates rapid recovery.