Anterior tibial artery pseudoaneurysm after ankle arthroscopy and Brostrom procedure treated with thrombin injection

Ankle arthroscopy and the Brostrom procedure are common interventions for ankle instability, but they do carry a risk of vascular injury resulting in a pseudoaneurysm. We present a rare case of anterior tibial artery pseudoaneurysm after ankle arthroscopy and Brostrom procedure treated with direct thrombin injection. A 40-year-old male patient presented with progressive left anterior ankle pain and swelling 5 months after a left ankle arthroscopy and Brostrom procedure. MRI and ultrasound imaging was consistent with anterior tibial artery pseudoaneurysm. He was referred to interventional radiology for treatment. His pseudoaneurysm was successfully treated with an ultrasound guided direct thrombin injection. Several potential treatments are available for treatment of pseudoaneurysms. This includes surgical intervention, endovascular treatment, external compression, and direct thrombin injection. All of these treatment options have been explored in literature. Of these possible treatments, direct thrombin injection has the best combination of efficacy, complication rate, and recurrence rate, which makes it the preferred treatment for a pseudoaneurysm.