Collagenase Clostridium histolyticum (CCH; Xiaflex) is an established nonsurgical therapy for Dupuytren contracture. Although adverse effects such as edema, ecchymosis, and skin tears are common, vascular injury is rare and pseudoaneurysm formation has not been previously described. Clinical evaluation and operative management of a patient who developed a digital artery pseudoaneurysm after CCH injection and manipulation were reviewed. A 66-year-old man developed a pulsatile swelling on the volar-radial aspect of the small finger 1 week after manipulation. Duplex ultrasound demonstrated a 1.8 × 1.5 × 1.9 cm partially thrombosed pseudoaneurysm with a 1.2 × 0.5 × 1.0 cm patent lumen arising from the radial digital artery. Surgical exploration revealed the artery entering the pseudoaneurysm with the digital nerve displaced centrally. The diseased arterial segment was excised and clipped proximally and distally. Digital perfusion remained intact and recovery was uneventful. Digital artery pseudoaneurysm is a potential, previously unreported complication of CCH injection for Dupuytren contracture. New or pulsatile swelling after manipulation should prompt vascular imaging to exclude this diagnosis.
Schwarz et al. (Mon,) studied this question.