Popliteal Artery Injury Research Articles

Traumatic popliteal artery spasm diagnosed using intraoperative angiography: A case report

There are few reports of traumatic arterial spasm in large-sized vessels in the extremities, and many surgeons are skeptical of its existence. We report a case of traumatic popliteal artery injury (PAI), which was later diagnosed as traumatic popliteal artery spasm on intraoperative angiography. A male patient, aged 54 years, was injured when a heavy object weighing approximately 100 kg fell on his right knee. Three hours after the injury, the patient was transported to our trauma center. The dorsalis pedis and posterior tibial arteries were not palpable, and his right lower leg was cold. However, he could move his ankle and toes completely and had no numbness or paresthesia in his right lower limb. Computed tomography angiography showed an interruption of the popliteal artery at the knee joint level and an enhancement on the distal side of the injury site. We diagnosed lower limb ischemia resulting from PAI and operated for revascularization. Under general anesthesia, the popliteal artery was explored via a posterior S-shaped incision in the prone position. No arterial abnormalities were observed macroscopically, and the injured area remained unidentified. Therefore, a contrast medium was injected into the popliteal artery using a 20-gauge intravascular needle, and angiography was performed, which revealed that the popliteal artery was patent; however, there was circumferential arterial stenosis at the level of the knee joint. At this point, the right lower limb's coldness had disappeared. Arterial spasm was speculated to cause the transient popliteal occlusion and lower leg ischemia. Immediate revascularization should be attempted when PAI is suspected. If no gross vascular abnormalities are confirmed, intraoperative angiography is useful for diagnosing arterial spasm.

Popliteal artery injury following total knee arthroplasty due to a very rare variant of the popliteal artery: A case report of an unusual complication.

Variations of the popliteal artery are uncommon but often associated with popliteal artery injuries. Thus, in cases of popliteal artery injury, popliteal artery variations should be one of the primary differential diagnoses. Due to the poor prognosis that may result in amputation or mortality, such injuries are serious complications that can lead to medical malpractice cases. This report presents a case of a 77-year-old woman with bilateral knee osteoarthritis who sustained a popliteal artery injury during total knee arthroplasty due to the highly uncommon type II-C popliteal artery variation. In light of the current literature, the pathology, diagnosis, and treatment of this case of popliteal artery injury, as well as the necessary precautions, have been discussed. The terminal branching pattern of the popliteal artery is essential for surgical planning and the ability to treat accidental artery injuries. To reduce the risk of popliteal artery injury, it is important to discuss the need for preoperative arterial color Doppler ultrasonography and magnetic resonance imaging to reveal the branching pattern and structure (arteriosclerosis and obstruction) of the popliteal artery (arteriosclerosis and obstruction).

Popliteal Artery Injuries: Incidence, Clinical Patterns and Outcomes (A Single Center Study in Yemen)

Background: Below the inguinal ligament, popliteal artery injuries are the second most frequent arterial injuries in the world. In order to share our experience with complex traumatic popliteal vascular injuries at Al-Thawra Modern General Hospital in Sana’a City- Yemen, we focus on the incidence, initial presentation, surgical management, and outcomes of popliteal artery injuries. Patients and Methods: Over the 3-year period from 1 January 2020 to 31 December 2022, all patients with popliteal artery injuries regardless of their other synchronized injuries were included. By contrast, patients who are managed as popliteal artery injuries by a military care giver at battle field were excluded from our analysis. In the diagnosis of popliteal artery injury, we relied on the physical examination. The main outcome was either patients get complete recovery, partial function loss of the limb, or end with amputation. Results: During study period, an overall incidence of popliteal artery injuries was 0.9%. Of 26 patients with popliteal artery injuries, 25 (96.2%) patients were men, and more than half of our patients (53.8%) were in the age group ≤ 25 years, with an overall mean of age 24.5 ± 5.6 years. The distribution of patients in groups of time delays in treatment of ≤ 6 hours, 6-10 hours and more than 10 hours was 9 (34.6%), 12 (46.2%) and 5 (19.2%) respectively. The mechanisms of injury were penetrating and blunt in 24 (92.3%) and 2 (7.7%) patients respectively. Patients who received a fasciotomy was 25 (96.2%). In our cohort of patients, incidence of amputation was 11.5%, while partial function loss rate was 27%. Conclusion and Recommendations: In our cohort of patients, incidence of popliteal artery injuries was high. Despite technical improvements in management of popliteal artery injury, a high amputation rate is observed in our study. The need for early diagnosis and early referral to definitive care must be emphasized. One of the most important ways to lower the risk of amputation is to shortening the duration of ischemia.

Revisiting the Mangled Extremity Severity Score (MESS) in Popliteal Artery Injury: A Single-Centre Experience in Vietnam.

Popliteal artery injury is a severe condition that can lead to limb loss. Early intervention is essential to achieve optimal outcomes, including limb salvage. The Mangled Extremity Severity Score (MESS) is a scoring system used to predict amputation rates for mangled limb injuries. The effectiveness of the MESS in predicting amputationin patients with traumaticpopliteal artery injury is unclear, particularly in settings with a high prevalence of motorcycle accidents. This retrospective study was conducted at a single center in Vietnam between January 2018 and June 2020. The study included 120 patients who underwent surgical treatment for popliteal artery injury. Data were collected from electronic medical records, radiology reports, and operative notes. Logistic regression model and the area under the curve (AUC) were used to evaluate the predictive value of the MESS. Patients with a MESS score of ≥8 had a higher rate of amputation compared to those with a MESS score of <8. However, the predictive value of the MESS was limited, with an AUC of 0.68. Higher skeletal/soft tissue injury score, limb ischemia score, and shock score were associated with a higher risk of amputation. The age score of the MESS was unexpectedly higher in the limb salvage group. The MESS score can be useful in predicting amputation rates in patients with popliteal artery injury, but its predictive value is limited. A team approach involving experienced surgeons is recommended for decision-making regarding amputation.

Popliteal Artery Injury and Loss of Limb After Intraosseous Needle Placement During Resuscitation

Popliteal Artery Injury and Loss of Limb After Intraosseous Needle Placement During Resuscitation

Fasciotomy in the treatment of acute lower extremity ischemia due to trauma, vascular wounds at Viet Duc University Hospital

Objective: The predominant groups of fasciotomy in the treatment of acute lower extremity ischemia due to trauma, vascular wounds at Viet Duc University Hospital. Methods: A retrospective, descriptive, non-control study on patients with a diagnosis of acute lower extremity ischemia who underwent revascularization with leg fasciotomy at Viet Duc University Hospital in the period from January 2020 to December 2021. Results: In 70 studied patients, the male/female ratio = 1.8/1; mean age was 33.2 ± 13.2 years old. Vessels damaged by trauma accounted for 94.3%, wounds accounted for 5.7%; mainly popliteal artery accounted for 88.6%. 75.7% of patients had associated lower extremity fractures or dislocations. Rutherford acute limb ischemia grade IIa or higher accounts for 95.7%. 100% of patients were revascularized at &gt;6 hours from the time of the accident. All patients were able to open the leg fascia right at the beginning; 74.3% performed by a team of orthopedic surgeons; 98.6% of leg fasciotomies were 2 incisions for 4 compartments. The average time of fasciotomy’s closure was 13.84 ± 6.445 days, the earliest was 4 days, the latest was 31 days. After 1 month of discharge, 82.4% of patients limited movement of the limbs; 48.5% of patients did not feel pain in the extremities after surgery. After 6 months, 33.8% of the patients had limited limb movement, 97.1% did not feel pain in the extremities. Conclusion: Leg fasciotomy in the treatment of acute lower extremity ischemia due to trauma or injury is performed, in which, the duration of limb ischemia &gt; 6 hours, popliteal artery injury and the acute limb ischemia classification according to Rutherford from IIa are the predominant groups.

Five-year outcomes after bypass graft versus Fogarty balloon catheter for the treatment of acute blunt popliteal artery injury.

To evaluate long-term clinical outcomes after revascularization by bypass graft versus Fogarty balloon catheter in acute blunt popliteal artery injury and identify risk factors contributing to amputation. A retrospective review was conducted in patients treated for acute blunt PAI between 2011 and 2019. Inclusion criteria were patients who underwent bypass graft and Fogarty balloon catheter. The cumulative limb salvage rate was calculated by the Kaplan-Meier test and compared with Breslow-Wilcoxon test. Cox proportional hazard model was performed to estimate the potential risk factors for amputation. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value for the potential risk factors. The overall limb salvage rate was 60.4% (29/48), including 24 patients (66.7%) in bypass graft, and 5 patients (41.7%) in Fogarty balloon catheter with mean follow-up of 5years (range, 2-10years). Among amputees, 15 patients (15/19, 78.9%) received primary amputation due to vascular failure or severe soft tissue damage, and 4 received secondary amputation because of chronic bone infection or neurologic deficit. Kaplan-Meier curves showed patients who received Fogarty balloon catheter had significantly higher amputation rate than those received bypass graft, with a hazard ratio of 3.801 (95% CI: 1.162-12.43, p = 0.009). In addition, Cox proportional hazard model revealed that MESS was the only independent risk factor for patients developing amputation, and the optimal cut-off value of MESS was 8. Five-year outcome demonstrated that Fogarty balloon catheter is not a safe procedure and has significantly higher amputation rate in severe blunt PAI. MESS is the only risk factor for amputation.

Reduced Time to Surgery and Prophylactic Fasciotomy May Result in Improved Outcomes in Popliteal Artery Injuries

Popliteal artery injuries are uncommon and often result in limb loss or long-term limb dysfunction. The aims of this study were (1) to evaluate the association between predictors and outcomes and (2) to validate the rational of systematic early fasciotomy. This retrospective cohort study included 122 patients (80% men, n=100) who underwent surgery for popliteal artery injuries from October 2018 to March 2021 in southern Vietnam. Primary outcomes included primary and secondary amputation. The associations between predictors and primary amputation were analyzed using logistic regression models. Among the 122 patients, 11 (9%) underwent primary amputation, while 2 (1.6%) had secondary amputation. Longer time to surgery was associated with increased odds of amputation (odds ratio=1.65; 95% confidence interval, 1.2 to 2.2 for every 6hr). Severe limb ischemia was also associated with a 50-fold increase in the risk of primary amputation (adjusted odds ratio=49.9; 95% confidence interval, 6 to 418, P=0.001). Furthermore, 11 patients (9%) without signs of severe limb ischemia and acute compartment syndrome on admission were found to have myonecrosis of at least one muscle compartment during fasciotomy. The data suggest that among patients with popliteal artery injuries, prolonged time before surgery and severe limb ischemia are associated with increased risk of primary amputation, whereas early fasciotomy may lead to improved outcomes.

Femoral fracture fixation followed by ipsilateral amputation: A case report

Severe crushing injury of the lower limb presenting as a concomitant femoral subtrochanteric fracture, ipsilateral open knee dislocation, and associated popliteal artery injury is unusual. Due to poor general and local conditions, despite a vascular repair, we performed a femoral fracture fixation followed by transfemoral amputation of the lower limb. The report aimed to demonstrate the effectiveness of this definitive treatment as one of the options in these difficult cases. The knee dislocation reduction was performed in the emergency operating room and the lower limb was stabilized with an external fixator. Vascular surgeons performed revascularization of the extremity with a femoropopliteal vascular bypass. Leg fasciotomies were performed and broad-spectrum antibiotics were administered. Several attempts at fasciotomy revisions and necrotic tissue debridement were made by plastic surgeons. Ten days after hospitalization, concomitant local rhabdomyolysis and deep soft-tissue infection lead to life-threatening sepsis. An above-the-knee amputation was quickly required. We performed an emergency proximal nailing of the femoral fracture and, subsequently, a transfemoral amputation at the distal third. In this case, we described the successful use of intramedullary nailing as a good option for stabilizing acute subtrochanteric fracture of a limb that required an above-the-knee amputation. This strategy saved the patient’s life, and intramedullary fixation with a short nail provided reliable bone stability for rapid and better functional recovery.

Traumatic Popliteal Artery Occlusion Following Lower Extremity Crush Injury Presenting With Isolated Patellar Dislocation.

While traumatic popliteal artery injury historically has a low incidence, failure to acutely recognize the vascular insult poses a significant risk of limb loss and functional impairment. A 71-year-old male presented with left lower extremity pain in setting of a crush injury working underneath a vehicle resulting in an isolated lateral dislocation of his patella and complete occlusion of the distal popliteal artery. He was taken to the operating room for an in-situ bypass and four-compartment fasciotomy. His hospital stay included three staged washouts/debridements with eventual closure. He was discharged after 38days to a rehabilitation facility with ability to self-ambulate with assistance within one month. This patient's presentation is unique for his isolated patellar dislocation without associated injuries characteristically associated with a traumatic vascular injury of the popliteal artery and serves to remind the importance of complete examination in the setting of blunt trauma.

Endovascular Repair of Popliteal Artery Injury Post-total Knee Arthroplasty is Safe and Effective: A Case Report and Systematic Review of the Literature

Objective: Popliteal artery pseudoaneurysms are a rare but serious complication following total knee arthroplasty (TKA) that have been traditionally managed with open surgical repair. Endovascular stenting, while relatively new, offers a promising alternative that is less invasive and may reduce the risk of peri-operative complications. A systematic literature review was conducted and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, post-procedural complications and follow-up data were extracted and analyzed using STATA 14.1. Additionally, we present a case of a patient with a popliteal pseudoaneurysm treated with a covered endovascular stent. A total of 14 studies (12 case reports, 2 case series; n= 17) were included for review. In all cases a stent-graft was placed across the popliteal artery lesion. In 5 out of 11 cases popliteal artery thrombus was present and treated with adjacent modalities (i.e. mechanical thrombectomy, balloon angioplasty, etc). Procedure success was reported in all cases without perioperative adverse events. Stents remained patent over a median follow up of 32 weeks (Interquartile range IQR: 36). In all but one case the patients experienced immediate symptom relief and had an uneventful recovery. For our case, at 12 months follow up the patient was asymptomatic, and ultrasound demonstrated vessel patency. Endovascular stenting is a safe and effective treatment for popliteal pseudoaneurysms. Future studies should be aimed at evaluating the long-term outcomes of such minimally invasive techniques.

Therapeutic management and amputation options in a long time delayed blunt popliteal artery injury.

To report the experience of treatment on blunt traumatic popliteal artery injury (PAI) combined orthopedic injuries and determine the amputation-associated factors. From January 2008 to December 2019, 55 patients in level I trauma center with traumatic blunt PAI were retrospectively reviewed. Variables were retrospectively collected and statistically analyzed. Patients with PAI with limb selvage, primary amputation, and secondary amputation were retrospectively grouped and compared. A total of 55 patients with a median age of 41.4years (range 18-70), of which 45 were males (81.8%) and 10 were females (18.2%), were enrolled. The overall amputation rate was 36.4% because 88.6% of patients faced more than 6h of delay before treatment. The average injury severe score (ISS) and abbreviated injury score (AIS) were 10.4 (range 9-34) and 8.2 (range 5-16), respectively. Multivariate regression analysis showed that the number of hospitalization days was a significantly related factor to amputation. After a median follow-up of 56months (range 12-132), no death, another limb loss, or claudication was found in all patients. Patients with PAI are commonly accompanied by multiple injuries that increase the risk of amputation; therefore, timely treatments are urgently required. Reducing the severity of ischemia by fasciotomy, not losing time by performing preoperative imaging or diagnostic tests, and repairing the associated venous injury can help to optimize the rates of limb salvage. However, impact factors, such as the gender and age of the patient, injured mechanisms, concomitant injuries, AIS, ISS, and surgical times, are not associated with the outcomes of amputation. Nonetheless, endeavors to salvage the limbs as far as possible should be made.

Balloon Catheter Technique for Prevention of Vascular Injuries During Arthroscopic Posterior Cruciate Ligament Reconstruction

Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure and is associated with several intraoperative and postoperative complications, although less-common but intraoperative iatrogenic popliteal artery injuries have been reported. At our center, we developed a simple and effective technique using a Foley balloon catheter that ensures a safe surgery to avoid possible neurovascular complications. Through a lower posteromedial portal, this inflated balloon acts as protective mechanism between the PCL and posterior capsule. Betadine or methylene blue dye is used to inflate this bulb, which provides easy identification if balloon ruptures, as evidenced by leakage of this solution in posterior compartment. This balloon increases significant distance, equivalent to the diameter of the balloon, between the PCL and popliteal artery by pushing the capsule more posteriorly. This balloon catheter protection technique combined with other methods will ensure a greater level of safety when performing an anatomical PCL reconstruction.

Cross-Leg Free Flap: Crossing the Border Zone of Ischemic Limb-A Case Report of Limb Salvage Procedure following a Delayed Diagnosis of Popliteal Artery Injury.

Vascular injury following traumatic knee injury quoted in the literature ranges from 3.3 to 65%, depending on the magnitude and pattern of the injury. Timely recognition is crucial to ensure the revascularization is done within 6 to 8 hours from the time of injury to avoid significant morbidity, amputation, and medicolegal ramifications. We present a case of an ischemic limb following delayed diagnosis of popliteal artery injury after knee dislocation. Even though we have successfully repaired the popliteal artery, the evolving ischemia over the distal limb poses a reconstruction challenge. Multiple surgical debridement procedures were performed to control the local tissue infection. Free tissue transfer with chimeric latissimus dorsi flap was done to resurface the defect. However, the forefoot became gangrenous despite a free muscle flap transfer. His limb appeared destined for amputation in the vicinity of tissue and recipient vessels, but we chose to use a cross-leg free flap as an option for limb salvage.

Factors Predicting the Outcome of Musculoskeletal Injuries Associated with Vascular Trauma at a Tertiary Care Trauma Centre in South India

Introduction: Vascular injuries are uncommon in civilian settings and present after blunt and or penetrating trauma. These injuries require timely intervention to prevent loss of limb or life. The impact of vascular injuries is well described in the Western population; however, there is a lack of evidence of factors predicting the outcomes of vascular injuries associated with musculoskeletal trauma in the Indian population. Methods: The retrospective data of consecutive trauma patients presenting to our emergency/outpatient department were collected over 5 years from January 2014 to December 2019 from our electronic medical records. After clinical assessment and/or radiological findings, patients were considered for either nonoperative management or vascular repair. Orthopedic intervention preceded vascular repair to attain skeletal stabilization and to protect vascular repair. Outcomes were measured in terms of baseline demographic variables, clinical determinants, pattern of injury, type of management, limb salvage, and primary or secondary amputations and mortality. Results: There were a total of 109 (92%) males and 3 (8%) females with an age range from 11 to 71 years (median = 35.5). The majority of the injuries were in the 30–50 years age group (n = 50, 50%). Limb salvageability was attained in 81 (72.3%) patients. Twenty patients (17.9%) underwent primary amputations and 11 (9.8%) patients required secondary amputations. Blunt trauma, lower limb involvement, multiple fractures, the Mangled Extremity Severity Score (MESS), and popliteal artery injury were significant predictors of limb salvageability. Stepwise multiple regression analysis identified multiple fractures (P = 0.011) and MESS (P = 0.000) as ultimate predictors of limb outcome. Conclusion: Revascularization is critical to the success of limb salvage in patients with traumatic vascular injury. Concomitant orthopedic injuries pose significant challenges and are associated with a high risk of limb loss. Multiple fractures and MESS score ≥6 prognosticates poor limb salvageability.

Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter.

Lower limbs are frequently involved in vascular trauma, but it is still not clear which factors lead to unfavorable clinical outcomes. To determine the clinical profile of patients with femoropopliteal injuries, the trauma mechanisms, and treatment and identify which factors led to unfavorable outcomes. A retrospective study based on the medical records of patients treated from 2017 to 2021. The following data were assessed: sex, age, distance to reach the hospital, trauma mechanism, hypovolemic shock, additional injuries, treatment of vascular injuries, whether fasciotomy was needed, inappropriate intraoperative decisions, and injury severity score. Need for surgical reintervention, amputation, and death were defined as unfavorable outcomes. Univariate, bivariate, and logistic regression analyses were conducted. The sample comprised 94 patients; 83% were men; mean age was 30.8 years; combined arterial and venous injuries prevailed (57.5%); and superficial femoral vessels were the most affected (61.7%). Penetrating mechanisms prevailed (80.9%). Arterial injuries were most frequently treated with venous graft (59.6%) and venous injuries underwent ligation (81.4%). In 15% of cases, inappropriate surgical decisions were detected; most often use of the ipsilateral great saphenous vein for arterial reconstruction. Unfavorable outcomes occurred in 44.7%: surgical reintervention was necessary in 21.3% and limb amputation in 25.5%, while 9.5% of the patients died. These injuries mainly involved young men, victims of gunshot wounds. Superficial femoral vessels were the most injured; concomitant non-vascular trauma was frequent, mainly fractures. Inappropriate surgical decisions increased the need for reinterventions by 34 times. Need for fasciotomy, presence of fracture/dislocation, blunt trauma mechanism, and popliteal artery injury increased the risk of amputation.

Delayed Management of Popliteal Artery Injury Following Knee Dislocation—A Case Report

Delayed Management of Popliteal Artery Injury Following Knee Dislocation—A Case Report

Clinical Patterns and Outcomes in Patients After Penetrating Lower Limb Vascular Injury in Taiz, Yemen

Background: Popliteal arterial injury is associated with a high risk of limb loss of any peripheral vascular injury. The purpose of this study was to review our experience with complex penetrating popliteal arterial injuries, thereby focusing on initial presentation and early outcomes. Methods: We conducted a retrospective study of 85 patients with popliteal arterial injuries who underwent surgical treatment from 2015 to 2019 at Authority of Althawra hospital in Taiz, Yemen. Variables were retrospectively collected included patient demographics, mechanism and type of injury, limb ischemia time, clinical status at presentation, type of vascular reconstruction, associated complications, limb salvage, and mortality

Lower Extremity Staged Revascularization (LESR) as a new innovative concept for lower extremity salvage in acute popliteal artery injuries: a hypothesis

Popliteal artery injury following knee dislocation is associated with significant morbidity and high amputation rates. The complex and multi-disciplinary input required to manage this injury effectively can take time to arrange, prolonging the time to revascularization. Furthermore, open surgical bypass or interposition graft can be technically challenging in the acute setting, further prolonging ischemic time.Temporary intravascular shunts can be used to temporarily restore flow but require surgical exposure which takes time. Endovascular techniques can decrease the time to revascularization; however, endovascular popliteal stent-grafting is controversial because the biomechanical forces relating to flexion and extension of the knee may increase the risk of stent thrombosis. An ideal operation would result in rapid revascularization, eventually leading to a definitive and durable surgical solution.We hypothesize that a staged approach combing extracorporeal shunting, temporary endovascular covered stent placement, external fixation of bony injury, and definitive open repair provides for a superior approach to popliteal artery injury than current standard of care. We term this approach lower extremity staged revascularization (LESR) and the aim is to minimize the known factors contributing to poor outcomes after traumatic popliteal artery injury.

The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury

PurposeVascular injuries in lower extremity trauma, especially with involvement of the popliteal artery, are associated with considerably high rates of limb loss, especially with blunt trauma mechanisms. The aim of this study was to evaluate the risk of amputation in patients with traumatic popliteal artery lesions with special focus on the validity of the Mangled Extremity Severity Score (MESS).MethodsIn this retrospective study, all patients treated for isolated lesions of the popliteal artery following trauma between January 1990 and December 2020 at a high-volume level I trauma center were included. Primary outcome was limb salvage dependent on MESS and the influence of defined parameters on limb salvage was defined as secondary outcome. The extent of trauma was assessed by the MESS.ResultsA total of 50 patients (age 39.2 ± 18.6 years, 76% male) with most blunt injuries (n = 47, 94%) were included. None of the patients died within 30 days and revascularization was attempted in all patients with no primary amputation and the overall limb salvage rate was 88% (44 patients). A MESS ≥ 7 was observed in 28 patients (56%) with significantly higher rates of performed fasciotomies (92.9% vs. 59.1%; p < 0.01) in those patients. MESS did not predict delayed amputation within our patient cohort (MESS 8.4 ± 4.1 in the amputation group vs. 8.1 ± 3.8 in the limb salvage group; p = 0.765).ConclusionRevascularization of limbs with isolated popliteal artery injuries should always be attempted. MESS did not predict delayed amputation in our cohort with fasciotomy being an important measure to increase limb salvage rates.