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Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy

Kickuth, Ralph ; Anderson, Suzanne ; Peter-Salonen, Kristiina ; Lämmle, Bernhard ; Eggli, Stefan ; Triller, Jürgen

In: CardioVascular and Interventional Radiology, 2006, vol. 29, no. 6, p. 1132-1135

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    Titre
    • Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy
    Auteur
    • Kickuth, Ralph. Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Berne, Switzerland
    • Anderson, Suzanne. Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Berne, Switzerland
    • Peter-Salonen, Kristiina. Department of Hematology, Inselspital, University of Berne, Berne, Switzerland
    • Lämmle, Bernhard. Department of Hematology, Inselspital, University of Berne, Berne, Switzerland
    • Eggli, Stefan. Department of Orthopedic Surgery, Inselspital, University of Berne, Berne, Switzerland
    • Triller, Jürgen. Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Berne, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • CardioVascular and Interventional Radiology, 2006, vol. 29, no. 6, p. 1132-1135. Springer-Verlag; www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:315013
    Summary
    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 subsititution 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