[Management of blunt injury of the popliteal artery]

Abstract

Purpose: this retrospective study was undertaken to analyse our results with blunt popliteal artery injury and to detect flaws in our approach.

Material and method: between 1979 and 1993, 31 consecutive patients with a blunt injury to the popliteal artery were retrospectively reviewed.

Results: 4 patients were in shock on admission from a popliteal artery bleed. One patient died before treatment. Primary amputation of the leg was performed in one patient because of extensive tissue destruction. Arterial reconstruction was performed in the remaining 29 patients: 1 patient died of associated injuries, 5 underwent subsequent limb amputation because of infection (in 2), tissular destruction (in 2) and persistent ischemia (in 1). A neurological deficit (mostly of the peroneal nerve) occurred in 13 patients. Increased ischemic time was noted in 6 patients because of non-optimal management: diagnosis of a popliteal artery occlusion was missed in 2 patients, and a rigid approach resulted in an excessive delay in revascularization in 4 patients.

Discussion: even though morbidity of blunt popliteal artery injury is greatly determined by the initial trauma, superimposed ischemia further jeopardizes the outcome. A more expeditive revascularization could be achieved in some patients by performing on-table angiograms, immediate fasciotomy to release tissue hypertension and by proceeding with the vascular repair before orthopedic reconstruction. However, if a complex orthopedic repair must be performed initially because of major instability, indwelling shunts should be inserted in the popliteal vessels to insure limb perfusion.

Conclusion: it is postulated that a rational plan of management of blunt popliteal artery injury would decrease the adverse effect of ischemia, and would reduce overall morbidity.