title: Hemophilia A pseudoaneurysm in a patient with high responding inhibitors complicating total knee arthroplasty: embolization: a cost-reducing alternative to medical therapy.
abstract: Joint hemorrhages are very common in patients with severe hemophilia. Inhibitors in patients with hemophilia are allo-antibodies that neutralize the activity of the clotting factor. After total knee replacement, rare intra-articular bleeding complications might occur that do not respond to clotting factor replacement. We report a 40-year-old male with severe hemophilia A and high responding inhibitors presenting with recurrent knee joint hemorrhage after bilateral knee prosthetic surgery despite adequate clotting factor treatment. There were two episodes of marked postoperative hemarthrosis requiring extensive use of substitution therapy. Eleven days postoperatively, there was further hemorrhage into the right knee. Digital subtraction angiography diagnosed a complicating pseudoaneurysm of the inferior lateral geniculate artery and embolization was successfully performed. Because clotting factor replacement therapy has proved to be excessively expensive and prolonged, especially in patients with inhibitors, we recommend the use of cost-effective early angiographic embolization.
authors.affiliation: Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Berne, Switzerland. ralph.kickuth@insel.ch
authors.forename: Ralph
authors.initials: R
authors.lastname: Kickuth
authors.forename: Suzanne
authors.initials: S
authors.lastname: Anderson
authors.forename: Kristiina
authors.initials: K
authors.lastname: Peter-Salonen
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lämmle
authors.forename: Stefan
authors.initials: S
authors.lastname: Eggli
authors.forename: Jürgen
authors.initials: J
authors.lastname: Triller
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000191:economics / Q000209:etiology / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics; D003029:Coagulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004621:Embolization, Therapeutic / Q000191:economics*; D006395:Hemarthrosis / Q000191:economics / Q000209:etiology / Q000628:therapy*; D006467:Hemophilia A / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male
chemical_list: D003029:Coagulants