All four patients who had arterial ligation performed proximal to the inguinal ligament were critically ischemic after ligation while when the level of ligation was below the inguinal ligament 14 out of 16 patients were compensated (significant).Pedal doppler flow signal was detected in ten patients only intraoperatively. However, four more patients regained Doppler signal in the ward few hours after the operation. All 14 patients with Doppler signal were compensated and required no further revascularization for limb salvage till discharge from hospital.In compensated patients the mean pre-operative ABI was 0.88 and the mean post-operative ABI was 0.49 with an average ABI drop of 0.39. However, in patients who required revascularization or amputation, the mean preoperative ABI was 0.83 and the mean post-operative ABI was 0.00 with an average ABI drop of 0.83 Conclusion -In drug addicts with infected femoral pseudoaneurysms, arterial ligation with local debridement without revascularization salvaged 70% of limbs in our study. The detection of pedal Doppler flow after ligation can stratify patients in whom revascularization might not be required for limb salvage. Additionally all efforts should be made to ligate the femoral artery below the inguinal ligament to preserve important juxta-inguinal collateral branches that can have great impact on limb outcome after ligation.
Case: A 17-year-old male patient presented with Salter-Harris type I hyperextension injury of left distal femur with delayed development of acute limb ischemia secondary to popliteal artery injury. Conclusion: Popliteal artery injury associated with distal femoral physeal fracture may not be clinically obvious at the time of initial presentation. When initial pulse examination and segmental Doppler measurements are normal, it is important to perform serial examination by experienced examiners because arterial insufficiency may develop over the subsequent 48 hours. If unidentified, this can lead to significant disability and/or limb loss. This emphasizes the importance of serial monitoring along with judicious use of ankle brachial pressure index, pulse oximetry, and imaging.
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