European Journal of Molecular & Clinical Medicine

Abstract

Injuries to the popliteal artery from blunt or penetrating trauma are routinely found in trauma centres. Early detection of the possibility of arterial injury is crucial for the limb salvage.
Material and methods: We retrospectively reviewed the records of the patients who were managed for popliteal artery injury at our institution during the study period (2020-2022). 30 Patients were treated during the study period 2020-2022. Information extracted and analysed included demographic data, clinical presentation, physical examination, blood investigation, colour Doppler. Surgical data included vessel injury, technical aspects of repair, associated complications and outcomes.
Results: There were 30 patients: 22males (73.3%) and 8 females (26.6%). Mean age ± SD was 24.7 ± 5.8 years. Most patients (90%) were under the age of 30 years. Blunt trauma was the common cause of popliteal artery injury (60%) and penetrating trauma accounted for 40% which included traumatic and iatrogenic injuries during orthopaedic procedures. All the patients had associated skeletal injury. Concurrent popliteal vein injury with popliteal artery injury was seen in 36.6% of patients. All patients had undergone popliteal artery bypass with reverse great saphenous vein graft harvested from the contralateral lower limb and popliteal vein injury was managed with vein ligation. Mean ischemia time at presentation was 9.26 hrs ±3.91. Five patients had delayed presentation. Seven patients (23.3%) underwent amputation. Of these 5 sustained tibial plateau fractures and 2 both bone fracture associated with severe soft tissue injury. There were no intraoperative or in-hospital deaths. Associated skeletal injury was managed by orthopaedic department.
Conclusion: Popliteal artery injury represents a great challenge due to their complexity and low frequency. Early diagnosis and surgical repair is recommended. Despite technical improvements in management of popliteal artery injury, a high amputation rate is still seen, especially in patients with extensive soft-tissue injury, associated skeletal trauma especially with tibial plateau fracture. Liberal use of fasciotomies, perioperative anticoagulation, antibiotics and presence of orthopaedician for skeletal fixation play an important role to achieve acceptable outcome.