Complete popliteal artery transection in the setting of blunt trauma

Abstract

Popliteal artery injury (PAI) in the setting of blunt trauma is a rare but highly comorbid condition associated with significant long-term disability, limb loss, and even mortality. We report the rare case of a completely transected popliteal artery in the setting of blunt trauma and isolated posteromedial tibiofemoral dislocation. A 41-year-old morbidly obese male presented after a fall from a ladder with his left leg trapped in one of the rungs. Computed Tomography-Angiography demonstrated left popliteal artery injury with active extravasation, no distal flow, and a rotary posteromedial tibiofemoral dislocation. After bony reduction was performed, operative exploration demonstrated complete transection of both the popliteal artery and vein. The vein was ligated, and the artery repaired with an anatomically tunneled superficial femoral artery to below-knee popliteal artery bypass. In addition, four-compartment fasciotomies of the lower extremity were performed along with external fixation of the knee joint. The patient was discharged after serial debridements, split-thickness skin grafting, and wound vac therapy. At eight-month follow-up the patient is ambulating without pain or claudication and the bypass graft remains patent on duplex ultrasound. This case highlights 1) the importance of clinical presentation and high degree of suspicion for popliteal injury in guiding management and 2) factors that have improved outcomes after traumatic popliteal artery injuries.