Endovascular Therapy as an Emerging Paradigm for the Treatment of Popliteal Artery Thrombosis Following Total Knee Arthroplasty: A New Approach to Acute Limb Ischemia Management

Abstract

Objectives: The objective of this research was to examine the occurrence, clinical features, treatment approaches, and results associated with a rare complication of thrombosis of the popliteal artery after total knee arthroplasty (TKA), leading to acute limb ischemia (ALI). Methods: A retrospective study on 1020 TKA procedures spanning 5 years. Cases of ALI were identified through clinical evaluation and arterial Doppler studies. Peripheral angioplasty was done to recanalize the popliteal artery. Manifestations, complications, and management strategies were evaluated. Results: Among the 1020 TKA cases, 5 cases of ALI were identified which accounts for 0.49% of all TKA cases. Female predominance and left-sided presentations are notable observations. Most patients presented within 8 hours of symptom onset with diverse complications ranging from foot drop to compartment syndrome. Except for 1 case, all patients recovered with thrombosuction and balloon dilatation. Conclusions: A rare but potentially fatal complication of TKA is popliteal artery thrombosis leading to ALI so it becomes important for early recognition and intervention to mitigate the adverse outcomes. In our study, endovascular treatment has emerged as the preferred modality in terms of effective management and reducing complications and morbidity from surgical procedures.

Keywords: arthroplasty; endovascular intervention; popliteal artery; thrombectomy; thrombosis.

Fig. 1 (A) Image depicts the thrombotic occlusion of the popliteal artery (red arrow). (B) Thrombosuction using a thrombuster catheter (red arrow). (C) Balloon dilatation of the popliteal artery (red arrow).

Fig. 2 (A) Thrombus aspirated from popliteal artery. (B) Aspirated thrombus.

Fig. 3 (A) Images show the post-endovascular therapy outcome of the popliteal artery. (B) Anterior and posterior tibial artery demonstrating satisfactory blood flow. (C) Dorsalis pedis arteries demonstrate satisfactory blood flow.

Fig. 4 (A) Aneurysm formation secondary to trauma to popliteal artery in left total knee arthroplasty with pre-angiographic image thrombotic occlusion of popliteal artery (red arrow). (B) Post-angiographic images after endovascular repair for thrombotic occlusion (red arrow).

Fig. 5 (A) A pre-angiographic image red arrow shows thrombotic occlusion of the popliteal artery. (B) The post-angiographic image illustrates endovascular intervention for thrombotic occlusion in the left popliteal artery post-total knee arthroplasty with mild residual thrombus (red arrow).