Limb Viability Research Articles

Effects of Local Hypothermia on Limb Viability in a Swine Model of Acute Limb Ischemia During Prolonged Damage-Control Resuscitation.

New strategies are needed to mitigate further tissue injury during traumatic limb ischemia in cases requiring damage control resuscitation (DCR). Little is known about the pathophysiology and injury course in acute limb ischemia (ALI) with DCR in polytraumatized casualties. We therefore investigated the effects of therapeutic limb hypothermia in a swine model of ALI and DCR. Fifteen swine underwent a published 6-hour DCR protocol of hemorrhage and then resuscitation. After hemorrhage, animals were randomized to 5oC or 15oC cooling of one hindlimb; the contralateral limb serving as an uncooled control. Physiologic variables, limb temperature, and limb tissue metabolites (glucose, lactate, and pyruvate) were measured throughout the DCR protocol. Muscle and nerve biopsies were obtained after the 6-hour protocol. Lactate and pyruvate levels were significantly lower in the cooled limbs than in the uncooled control limbs but did not differ between the 5oC and 15oC groups. Tissue glucose levels did not differ between the 5oC group, the 15oC group, and controls. Mean histologic muscle score was significantly higher in the 5oC group than in controls (p = 0.03). Mean nerve histology scores did not differ between the 5oC and paired control limbs, or between the mean muscle and nerve histology scores of the 15oC and paired control limbs. Cooling to 15oC significantly reduced local tissue metabolites compared to paired controls, while producing no significant increase in histologic damage, whereas cooling to 5oC increased histologic muscle damage. These results suggest an approach to prevention of ischemic injury through local hypothermia but warrant further functional testing.

Effect of Subnormothermic Machine Perfusion on the Preservation of Vascularized Composite Allografts After Prolonged Warm Ischemia.

Warm ischemia time (WIT) and ischemia-reperfusion injury are limiting factors for vascularized composite allograft (VCA) transplantation. Subnormothermic machine perfusion (SNMP) has demonstrated the potential to extend WIT in organ transplantation. This study evaluates the effect of SNMP on VCA viability after prolonged WIT. Rat hindlimbs underwent WIT for 30, 45, 60, 120, 150, or 210 min, followed by 3-h SNMP. Monitoring of perfusion parameters and outflow determined the maximum WIT compatible with limb viability after SNMP. Thereafter, 2 groups were assessed: a control group with inbred transplantation (Txp) after 120 min of WIT and an experimental group that underwent WIT + SNMP + Txp. Graft appearance, blood gas, cytokine levels, and histology were assessed for 21 d. Based on potassium levels, the limit of WIT compatible with limb viability after SNMP is 120 min. Before this limit, SNMP reduces potassium and lactate levels of WIT grafts to the same level as fresh grafts. In vivo, the control group presented 80% graft necrosis, whereas the experimental group showed no necrosis, had better healing (P = 0.0004), and reduced histological muscle injury (P = 0.012). Results of blood analysis revealed lower lactate, potassium levels, and calcium levels (P = 0.048) in the experimental group. Both groups presented an increase in interleukin (IL)-10 and IL-1b/IL-1F2 with a return to baseline after 7 to 14 d. Our study establishes the limit of WIT compatible with VCA viability and demonstrates the effectiveness of SNMP in restoring a graft after WIT ex vivo and in vivo, locally and systemically.

Efficacy of damage control orthopedics strategy in the management of lower limb trauma

BackgroundLittle is known about the efficacy of damage control (DC) surgery in the management of lower limb trauma. Here we compared the clinical parameters and complication rates of such patients received either DC or emergency comprehensive (EC) surgery treatment. MethodsThis study is a retrospective study on patients with lower limb trauma that received surgical treatment. Data of 120 patients were divided into DC and EC surgery groups. Clinical parameters obtained at hospital admission and complications during follow-up were analyzed. Injury Severity Score (ISS), Gustilo classification and Mangled Extremity Severity Score (MESS) were used to assess trauma severity, open fractures and viability of injured limb, respectively. ResultsAge, sex, ISS, fracture type, injury site, MESS, operation time, blood loss, pulmonary and cranial injuries were compared. We found that patients in the DC group had more severe injury as reflected by the higher injury severity score (ISS) (28.1 ± 10.9 vs 21.3 ± 7.4, P < 0.001). ISS was also identified as a significant influencer for the treatment selection (P < 0.001). In addition, patients treated with DC surgery demonstrated less complications (7 cases vs 27 cases), which was supported by the propensity score logistic regression analysis (Odd ratio 4.667). ConclusionsDC surgery is more often selected to treat patients with more severe lower limb injuries, which leads to lower complication rates.

Poly(ethylenimine)-Cyclodextrin-Based Cationic Polymer Mediated HIF-1α Gene Delivery for Hindlimb Ischemia Treatment.

Hindlimb ischemia is a common disease worldwide featured by the sudden decrease in limb perfusion, which usually causes a potential threat to limb viability and even amputation or death. Revascularization has been defined as the gold-standard therapy for hindlimb ischemia. Considering that vascular injury recovery requires cellular adaptation to the hypoxia, hypoxia-inducible factor 1 α (HIF-1α) is a potential gene for tissue restoration and angiogenesis. In this manuscript, effective gene delivery vector PEI-β-CD (PC) was reported for the first application in the hindlimb ischemia treatment to deliver HIF-1α plasmid in vitro and in vivo. Our in vitro finding demonstrated that PC/HIF-1α-pDNA could be successfully entered into the cells and mediated efficient gene transfection with good biocompatibility. More importantly, under hypoxic conditions, PC/HIF-1α-pDNA could up-regulate the HUEVC cell viability. In addition, the mRNA levels of VEGF, Ang-1, and PDGF were upregulated, and transcriptome results also demonstrated that the cell-related function of response to hypoxia was enhanced. The therapeutic effect of PC/HIF-1α-pDNA was further estimated in a murine acute hindlimb ischemia model, which demonstrated that intramuscular injection of PC/HIF-1α-pDNA resulted in significantly increased blood perfusion and alleviation in tissue damage, such as tissue fibrosis and inflammation. The results provide a rationale that HIF-1α-mediated gene therapy might be a practical strategy for the treatment of limb ischemia.

Acute limb ischemia due to left brachial artery occlusion in a 40-year-old female patient: a case report

Acute upper limb ischemia (ALI) due to brachial artery occlusion is a rare but catastrophic condition that poses a significant threat to limb viability and can result in limb amputation or death. Accurate diagnosis and timely intervention are crucial to avoid catastrophic consequences. Literature on ALI due to brachial artery occlusion is scant and usually related to atrial fibrillation. We report a 40-year-old female presented with sudden onset left upper limb pain, change in color, and neurological deficits in the last three days. A color Doppler ultrasound revealed a complete occlusion of the left brachial artery with echogenic thrombosis suggestive of ALI. The patient urgently underwent a thrombectomy with an uneventful outcome. In conclusion, even though ALI due to brachial artery occlusion is rare, a heightened level of suspicion, precise diagnosis, and timely management are essential to prevent any fatal consequences.

A Case of Traumatic Hand Ischemia – Managed Successfully with Neurovascular and Soft-tissue Reconstruction

Upper limb has rich vascular supply due to sufficient collaterals around the shoulder, elbow, and wrist joints which prevents ischemia and maintains viability of the upper limb in case of vascular injury or occlusion. There are numerous literature available, regarding the management of isolated single arterial injury in the forearm, which suggest that ligation of single artery (radial or ulnar) is safer if the companion arterial supply is intact. Hand salvage becomes more challenging when patient presents with acute hand ischemia following injury to both forearm arteries and has associated musculoskeletal injuries. We hereby report the case of a 24-year-old male who sustained glass-cut injuries to his right distal forearm resulting in both forearm arterial, nerves, flexor tendon injuries, and presented as acute hand ischemia. The patient was managed by reconstruction of radial and ulnar arteries using reverse saphenous vein graft (RSVG) along-with primary repair of median and ulnar nerves and flexor tendons. Skin and soft tissue defect was subsequently covered using antero-lateral thigh flap. The prompt and timely management of patient resulted in hand salvage with good functional outcome.

Spectrum of Acute Limb Ischemia and Management – A Single-center Study in Northern India

Background: Acute limb ischemia (ALI) can be defined as sudden deterioration in limb perfusion, often producing new or worsening symptomatology and usually threatening limb viability. The incidence of ALI is approximately 1.5 cases per 10,000 persons per year. Objective: The main objective of the study is to assess the spectrum of ALI and effective management options in a tertiary care center. Methodology: This was a retrospective and prospective observational study. All patients admitted in tertiary care center with ALI were included in this study. The medical records of patients admitted since last three years were collected retrospectively and the data of patients with ALI getting admitted during next one year was collected simultaneously. Patients who were included prospectively were followed for at least one month. Results: In the study period, we received 136 patients with 138 ALI (ALI presenting with 14 days = 95, ACLI = 17, ALI with delayed presentation = 26). Average age of patients was 47.4 years. 21 to 40 years age group made the largest cohort of 56 patients. 10.79% of the lower limb ischemia were female (15 out of 136). Among these categories, the outcomes depend upon the time of presentation (earlier presentation has the better outcomes in terms of limb salvage). The delayed presentation of ALI has poorer outcome of amputation whereas mortality rates are higher in ALI presenting early. Patency in ALI is better due to embolus. Outcome of ALI due to embolus are best followed by acute thromboembolic occlusion without pre-existing CLI. The worst outcomes in amputation are for ACLI when they present late. Etiology wise Cardio embolic group comprised as the commonest cause; High Altitude Thrombosis also is very significant in our setting. Class II B ischemia which is most surgically amenable, and the amputation rate is 20%. Conclusion: In our study, outcome of various modalities of management of ALI has been evaluated. Our study provided data which could be accessed to define the outcome and most amenable to any useful intervention affecting outcome in patients of limb ischemia. Revascularization in ALI is aimed not only to prevent amputation but also to limit the level of amputation which is a forgotten aspect of salvage procedure in lower extremity.

Tourniquet-induced ischemia creates increased risk of organ dysfunction and mortality following delayed limb amputation

Tourniquets are critical for the control of traumatic extremity hemorrhage. In this study, we sought to determine, in a rodent blast-related extremity amputation model, the impact of prolonged tourniquet application and delayed limb amputation on survival, systemic inflammation, and remote end organ injury. Adult male Sprague Dawley rats were subjected to blast overpressure (120±7 kPa) and orthopedic extremity injury consisting femur fracture, one-minute soft tissue crush injury (20 psi), ± 180 min of tourniquet-induced hindlimb ischemia followed by delayed (60 min of reperfusion) hindlimb amputation (dHLA). All animals in the non-tourniquet group survived whereas 7/21 (33%) of the animals in the tourniquet group died within the first 72 h with no deaths observed between 72 and 168 h post-injury. Tourniquet induced ischemia-reperfusion injury (tIRI) likewise resulted in a more robust systemic inflammation (cytokines and chemokines) and concomitant remote pulmonary, renal, and hepatic dysfunction (BUN, CR, ALT. AST, IRI/inflammation-mediated genes). These results indicate prolonged tourniquet application and dHLA increases risk of complications from tIRI, leading to greater risk of local and systemic complications including organ dysfunction or death. We thus need enhanced strategies to mitigate the systemic effects of tIRI, particularly in the military prolonged field care (PFC) setting. Furthermore, future work is needed to extend the window within which tourniquet deflation to assess limb viability remains feasible, as well as new, limb-specific or systemic point of care tests to better assess the risks of tourniquet deflation with limb preservation in order to optimize patient care and save both limb and life.

Acute limb ischemia in patient with COVID-19 infection

The severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 caused a worldwide pandemic and became a massive problem in our healthcare system. This infection has broad clinical presentation from asymptomatic to severe symptoms, and unfortunately death. Hypercoagulability associated with this infection can cause a significant morbidity, that increased risk of microthrombosis, vascular hyperpermeability, disseminated intravascular coagulation, and multiorgan failure. Acute limb ischemia (ALI) is the one of coronavirus disease 2019 associated coagulopathy that threaten the limb viability in a very short interval. We report a case of a 98-year-old woman with coronavirus disease 2019 infection, then suddenly has ALI in the right foot.

The Classical 6-P of Acute Limb Ischemia

Acute limb ischemia (ALI) is a surgical emergency and often threatens limb viability. This is a case of a 45-year-old patient who presented with the classical six Ps of ALI. A 45-year-old lady with underlying hypertension and heart failure presented with acute right leg pain arriving by ambulance at the Emergency Department within 4 hours of the symptom. The patient was clinically obese and seemed very uncomfortable as evidenced by her writhing in pain. She was borderline tachycardic and hypertensive. The cardiopulmonary and abdominal examinations were unremarkable. On extremity examination, she was unable to move her right leg starting from the knee caudally. The leg appeared mottling and cold. On vascular examination, there was no abdominal or femoral bruit but there was a diminished pulsation of the right femoral, dorsalis-pedis and posterior-tibialis arteries as confirmed by Doppler compared to the contralateral side. On the neurological examination, the sensation was absent and no pain upon the passive stretch. Ankle-Brachial-Systolic Index (ABSI) was 0.7. As evidenced by pain, pallor, pulselessness, poikilothermia, paralysis, and paresthesia, clinical diagnosis of acute right leg ischemia was established with most likely vascular occlusion proximal to the left femoral artery. The vascular team was urgently referred. Electrocardiogram showed sinus tachycardia. Bedside ultrasound revealed normal aortic root size and neither aortic dissection nor aneurysm. 2-point compression tests were fully compressible and X-ray films showed no fracture. Creatinine Kinase was 65 units/litre whereas other blood parameters were unremarkable. She was then classified as Rutherford IIB and underwent a right femoral thromboembolectomy. The presentation of ALI requires rapid diagnosis and appropriate management as it is time-sensitive and limb-threatening. Emergency physicians should be aware of advances in endovascular therapies as a recommended option for the treatment of ALI. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S23

Sulforaphane protects microvascular endothelial cells in lower limb ischemia/reperfusion injury mice.

Background: Microvascular damage is a key pathological factor in acute lower limb ischemia/reperfusion (I/R) injury. Current evidence suggests that sulforaphane (SFN) protects tissue from I/R injury. However, the role of SFN in acute lower limb I/R injury remains elusive. This study aimed to investigate the role and potential mechanism of SFN in I/R-related microvascular damage in the limb. Methods: Limb viability was evaluated by laser Doppler imaging, tissue edema analysis and histological analysis. Western blotting and immunofluorescence were applied to analyze the levels of apoptosis, oxidative stress, autophagy, transcription factor EB (TFEB) activity and mucolipin 1 (MCOLN1)-calcineurin signaling pathway. Results: SFN administration significantly ameliorated I/R-induced hypoperfusion, tissue edema, skeletal muscle fiber injury and endothelial cell (EC) damage in the limb. Pharmacological inhibition of NFE2L2 (nuclear factor, erythroid 2 like 2) reversed the anti-oxidation and anti-apoptosis effects of SFN on ECs. Additionally, silencing of TFEB by interfering RNA abolished the SFN-induced autophagy restoration, anti-oxidant response and anti-apoptosis effects on ECs. Furthermore, silencing of MCOLN1 by interfering RNA and pharmacological inhibition of calcineurin inhibited the activity of TFEB induced by SFN, demonstrating that SFN regulates the activity of TFEB through the MCOLN1-calcineurin signaling pathway. Conclusion: SFN protects microvascular ECs against I/R injury by TFEB-mediated autophagy restoration and anti-oxidant response.

Etiology, Pathology and Treatment of Acute Limb Ischemia

When a blood vessel that provides blood to a limb becomes blocked it can result in oxygen and nutrients reaching the limb. This medical situation, referred to as limb ischemia (ALI), is a pressing issue that demands immediate medical intervention. This interruption can lead to tissue damage and the potential risk of limb loss. This abstract provides an overview of the management of ALI, which includes both endovascular treatments. It emphasizes the importance of considering patient factors and ensuring intervention. The management of ALI primarily relies on therapy, which involves using anticoagulation to prevent blood clot formation providing pain relief and, reducing metabolic demands through analgesics, ensuring perfusion through fluid resuscitation improving microcirculation with vasodilators and addressing infection risks with antibiotics. Several techniques, including endovascular techniques, offer options such as thrombolysis to dissolve clots that are blocking arterial flow. Successfully managing ALI requires assessment of the causes, severity of ischemia, availability of vascular expertise, and taking into account patient preferences and any existing health conditions. It is crucial to diagnose ALI and initiate treatment without delay in order to save viable limbs. The expertise and teamwork of healthcare professionals play a role in customizing interventions according to needs. In conclusion, effective management of ALI demands an approach that balances therapies with endovascular interventions while prioritizing patient-centered care and swift action. The preservation of limb function and overall well-being greatly depend on these considerations.

Reference Probe for TcpO2 at Rest: A Systematic Review

(1) Background: Transcutaneous oxygen pressure (TcpO2) is used to determine the severity of lower extremity arterial disease (LEAD). Many authors used a ratio of limb to chest TcpO2, also called the regional perfusion index (RPI), which should be independent of variations in oxygen delivery and reflective of local limb oxygen supply. The relevance of a reference probe-positioned TcpO2 electrode is debated. We aimed to review the relevance of the reference probe in previous studies using rest TcpO2. (2) Methods: We searched Medline and the Cochrane Central Register of Controlled Trials on 22 September 2022 using keywords related to TcpO2, reference probe and LEAD. (3) Results/Discussion: Fifteen studies were included in the review. Nine studies investigated LEAD severity (n = 9), amputation healing predication (n = 4), surgical outcome prediction (n = 2), therapeutic effect (n = 3) and difference according to diabetic status (n = 1). Four studies investigated more than 1 indication. Among 12 (16.7%) studies using RPI, only two authors found a benefit of using RPI instead of absolute TcpO2. Using only univariate analysis, one author reported that RPI was significantly related to viability at 1 year, while distal TcpO2 was not, on 13 limbs. The following year, the same author published a new study including 118 limbs that reported that RPI and absolute TcPO2 were both prognostic factors for limb viability at 1 year using a multivariate model. (4) Conclusions: Only one study firmly supporting the use of RPI, calculated using a reference probe on the arm, to predict BKA healing. Prospective studies are needed to validate this result; for other indications there is insufficient data supporting the use of a TcpO2 reference probe at rest.

Acute limb ischemia : Quick review for residents in interventional radiology

Knowledge of diagnosis and treatment of acute limb ischemia is essential to preserve limb viability and prevent irreversible damage. Abrief review of treatment options, patient selection, and management in acute limb ischemia is provided for residents in interventional radiology. The most commonly used interventional treatment options in acute limb ischemia including case studies and recommendations are provided. In acute limb ischemia, the decision between therapeutic procedures (interventional or surgical) depends on the clinical stage. There are three main interventional procedures: catheter-directed thrombolysis, thromboaspiration, and mechanical thrombectomy using specialized catheters; acombination of these procedures is also possible. The decision depends on various factors, some of which are center-specific, and should therefore always be made by interdisciplinary consensus. After near-complete revascularization, the cause should be sought and eliminated. In acase of suspected acute limb ischemia, patients should ideally be taken to an interdisciplinary center with interventional radiology and vascular surgery. After clinical evaluation and noninvasive imaging, adecision regarding possible therapeutic options can be made.

A PROSPECTIVE STUDY ON ACUTE LIMB ISCHEMIA - PRESENTATION, MANAGEMENT, OUTCOME- OUR INSTITUTIONAL EXPERIENCE

Introduction:Acute limb ischemia (ALI) a major vascular emergency defined as sudden decrease in limb perfusion that threatens limb viability. Prompt early recognition and management is need of hour to reduce the morbidity and mortality associated with ALI. The aim of this study is to emphasis on presentation, management and outcome of ALI for better understanding of disease and management Materials And Method: 1. Period Of Study - 10months from OCT 2021 - JULY 2022 2. Total No Of Patients – 100 3. Study method – prospective observational study Results: The study enrolled 100 patients with sudden onset of six Ps (pain, pallor, poikilothermia, pulselessness, paresthesia, paralysis) and treated within 14 days of onset. Mean age group was 47.32 (18-80yrs) and 72% were male and 28% female, among which 66% were lower limb and 34% upper limb ALI. 26%class I, 18% class IIa, 32%class IIb, 24% class III. All patients were primarily treated with anticoagulation and 26 recovered. 36 patients had systemic lytic therapy with inj. Alteplase. 13 CDT were performed. 23 patients underwent thrombo/embolectomy with a balloon catheter (Fogarty). 15 patients underwent surgical bypass following lytic therapy and had successful revascularization of limb. 39 patients finally ended up with amputation in spite of intervention. 4 patients died and all 4 had saddle embolus with B/L LL ALI. Conclusion: In patients presenting with ALI, Major limb salvage ability factors – type and class of ischemia, etiogical factor, time of presentation to vascular specialist.Time is essence in salvaging the limb in ALI – act FAST.Class III ALI interventions have limb salvage ability rate of 17%, reduced the level of amputation and promotes stump healing- decreasing the morbidity.

Contrast radiography to determine limb viability in entangled sea turtles with constriction injuries.

Contrast radiography to determine limb viability in entangled sea turtles with constriction injuries.

INCIDENCE OF ACUTE LIMB ISCHEMIA IN COVID POSITIVE PATIENTS IN RGGGH, CHENNAI

Acute Limb Ischemia is dened as any sudden decrease in limb perfusion causing potential threat to limb viability. It can be caused by embolism or thrombosis. Commonly affects arteries of lower extremities. The risk factors for ALI can be multifactorial. The commonest include embolic predisposition like atrial brillation or coronary artery disease, trauma or thrombosis due to atherosclerosis or hypercoagulable state like malignancy, leukemia, Antiphospholipid syndrome, protein C /S/ antithrombin deciency, polycythemia vera, thrombocytosis. Thrombosis of a bypass graft is common in western countries which occurs at the site of anastamosis. A sudden and signicant increase of COVID-19–infected patients who were presenting with ALI has been noted at our institutions recently. A prothrombotic state, is present in patients with severe COVID-19 illness, where increased brin and brin degradation products are noted. This has been shown to adversely increase the severity of ALI and affect outcomes

Rare Case of Vasospastic Acute Limb Ischemia

Background: Acute limb ischemia (ALI) requires immediate treatment to maintain limb viability and prevent morbidity and mortality. Nevertheless, vasospastic acute limb ischemia on limb arteries is rarely reported.&#x0D; Case Illustration: This article reported a 37-year-old woman with sudden pain in her left leg and foot. The absence of peripheral pulsation of the left dorsalis pedis artery and popliteal artery were noted. Her foot was cold and clammy with decreased oxygen saturation in the left toes. The symptoms were partially improved following heparinization therapy. Angiography was conducted, and it revealed the spasms of the left popliteal and dorsalis pedis arteries with no sign of acute embolism or thrombosis. Arterial vasospasm is a rare cause of acute limb ischemia. A theoretical etiology of this vasospasm might be a secondary Raynaud's phenomenon. The associated factors were female, pre-menopausal age, the use of combined injectable contraception containing estrogen, and exposure to cold temperatures.&#x0D; Conclusion: This case report emphasizes the necessity to consider all possible causes in ALI-presenting cases to provide adequate therapy and prevent limb death.

Update in combined musculoskeletal and vascular injuries of the extremities.

Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily. Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage, duration of limb ischemia, patient’s medical status and presence of associated injuries. The management of these injuries is challenging and requires a specific algorithm of action, because they are usually characterized by increased morbidity, amputation rate, infection, neurological and functional deficits, and they could be life threatening. Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma, the high index of suspicion, imaging control, and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases. Even after a successful initial treatment of a combined trauma pattern, long-term follow-up is crucial to prevent and detect early possible complications. The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities, from an orthopedic point of view.

Popliteal Artery Injury Following Traumatic Knee Dislocation – Case Report

Knee dislocation is a devastating injury that can compromise the limb's viability. This trauma is associated with muscular and ligamentar extensive lesions. Obese patients can suffer of knee dislocation resultant from falls at the same level, and these “super-low” energy dislocations are associated with a surprising rate of neurovascular complications. The popliteal artery may be involved in up to 60% of cases, and the prognosis is considerably worse. In these cases an emergent approach is mandatory. Delayed diagnosis and treatment can result in up to 80% of amputations of the extremity. The authors present a patient that was admitted at the Emergency Room with knee pain and deformity after a fall at the same high. After the diagnose and reduction of the anterior dislocation, an echo-doppler and CT angiography were performed, and revealed a lesion in popliteal artery. After immobilized with a long leg plaster cast, the patient was transferred to a hospital with Vascular Surgery Department, and underwent revascularization of the limb. Despite the severity of the vascular injury the patient had a very good outcome.