J Korean Orthop Assoc.  2019 Aug;54(4):366-371. 10.4055/jkoa.2019.54.4.366.

Hemarthrosis Occurred after Arthroscopic Rotator Cuff Repair in a Chronic Renal Failure Patient with a Stenosis in an Ipsilateral Arteriovenous Fistula

• Huh SH
• Kim SJ
• Park JY
• Kang KR

• KMID: 2455506
• DOI: http://doi.org/10.4055/jkoa.2019.54.4.366

Abstract

Hemarthrosis occurring after arthroscopic surgery for lesions of the shoulder joint is a very rare complication that can develop due to an injury to the blood vessels when an anterior portal is formed. This is a complication that rarely develops in patients who are taking antithrombotic drugs or who do not have associated diseases, such as thrombocytopenia. We report a case of hemarthrosis that occurred after performing arthroscopic surgery to repair a rotator cuff tear in a patient with a stenosis in an arteriovenous fistula for hemodialysis in the ipsilateral upper arm.

Keyword

shoulder; arthroscopy; rotator cuff; hemarthrosis; arteriovenous fistula

MeSH Terms

Arm
Arteriovenous Fistula*
Arthroscopy
Blood Vessels
Constriction, Pathologic*
Hemarthrosis*
Humans
Kidney Failure, Chronic*
Renal Dialysis
Rotator Cuff*
Shoulder
Shoulder Joint
Tears
Thrombocytopenia

Figure

• 

  Figure 1 Plain radiographs showing the subacromial spur, proximal humeral migration and reduced acromiohumeral interval.

• 

  Figure 2 T2-weighted fat suppression magnetic resonance imaging. Axial (A), sagittal (B), and coronal (C) images showing a massive cuff tear with retraction.

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  Figure 3 Arthroscopic images. A partial subscapularis tear was observed and repaired using a single row technique (A), and full thickness tears of the supraspinatus and infraspinatus tendons were repaired using a suture bridge technique (B). There was no evidence of intra-articular bleeding during the procedure.

• 

  Figure 4 (A, B) On postoperative day 3, swelling was observed around the anterior portal, so joint aspiration was performed, and approximately 65 ml of dark-bloody fluid was drained. (C, D) Computed tomography angiography images. No dye leakage was observed, which implies vascular injury or a pseudoaneurysm, but a large collection of fluid around the joint was noted. Total occlusion of the cephalic vein (arrowhead) was observed, and subtotal stenosis of the axillary vein (empty arrow) and the outflow of the arteriovenous fistula (white arrow) was observed.

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  Figure 5 (A) Gross photograph of the arteriovenous fistula on the upper arm before ligation of the arteriovenous (AV) fistula. (B) After ligation of the AV fistula, a permanent catheter for dialysis was inserted through the contralateral internal jugular vein.

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