Lesiones de arteria poplítea durante la cirugía ortopédica de rodilla

Abstract

ObjectivesIatrogenic popliteal artery trauma associated with knee orthopedic surgery are extremely rare, but present high morbidity. The effect of concomitant orthopedic and vascular lesions in relation to limb loss in patients with lower extremity vascular lesions and their predictive factors is analyzed. Material and methodsA retrospective study of popliteal artery trauma associated with orthopedic knee surgery was designed in a single center. For this, the medical records were reviewed between October-1979 to October-2016. The mechanism of production, mode of repair and related complications were analyzed as main variables. ResultsDuring this period, 74 popliteal artery injuries were treated, of which 10 were associated with orthopedic surgery (13.5%). During those 36 years, 7,400 orthopedic interventions were performed (10 / 7,400, 0.1%). The injuries were secondary to 4 total knee prosthesis, 2 femur re-fractures, 2 tibia rod, 1 de-epifisiodesis and 1 osteosarcoma. The clinic was acute ischemia in 5 cases, hemorrhage in 2 and false aneurysm in 3. The median age was 43 years, with 3 in pediatric age. Were made 6 arteriographies and 2 angio-CT was required, since Doppler signal lacked diagnostic capacity. The repair was immediate (0-12h) in 3 patients, in 1 between 12-24hours and over 24hours in 6 occasions. All were medially treated, the majority of which were the saphenous vein (3), prosthetic interposition (2), simple suture (2) and plasticity with patch (1). There were 3 compartmental syndromes that required fasciotomies. On two occasions an amputation was necessary, both in late repair. The functional capacity was manifestly altered in 4 patients: 2 for major amputation and 2 for external popliteal sciatic nerve injury. ConclusionsLate repairs and with prosthetic material were associated with an increased risk of limb loss. An image test is always required, since the Doppler signal is not very specific. The success of repair is clearly associated with early diagnosis and repair. The association of nerve and venous injuries is accompanied by greater disability and complications.