Endovascular versus open repair of isolated superficial femoral and popliteal artery injuries

Potter, Helen A.; Alfson, Daniel B.; Rowe, Vincent L.; Wade, Niquelle Brown; Inaba, Kenji; O’Banion, Leigh Ann; Siracuse, Jeffrey J.; Magee, Gregory A.

doi:10.1016/j.jvs.2021.02.023

Cited by 19 publications

(10 citation statements)

References 30 publications

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“…Outside selected scenarios, the primary patency of a below-the-knee bypass with the saphenous vein remains superior [ 11 , 12 ]. A retrospective study of the National Trauma Data Bank of patients who suffered a blunt or penetrating injury of the superficial femoral artery and/or the popliteal artery reported an overall incidence of superficial femoral and/or popliteal arterial injury in 0.2% of all trauma patients [ 1 ]. Endovascular repair was performed in 5.7%, but interestingly, the authors noticed an increase in endovascular stent placement over the seven-year study period (3.2% in 2007 versus 7.6% in 2014), suggesting that endovascular repair is becoming more prevalent in the United States and Canada.…”

Section: Discussionmentioning

confidence: 99%

“…Comparative studies of patients undergoing open versus endovascular repair are limited to small retrospective cohorts but risks of limb loss appear similar in patients undergoing endovascular versus open repair. Potter et al reported that in-hospital amputation-free survival was similar between patients who underwent open versus endovascular repair, but their cohorts included patients with femoral and popliteal injuries [ 1 ]. Surprisingly, overall mortality was higher in those undergoing endovascular stenting while the rate of fasciotomy was lower.…”

Section: Discussionmentioning

confidence: 99%

“…Popliteal arterial trauma is relatively rare but carries a high risk for limb loss (up to 16%) and mortality (approximately 8%) [1][2][3][4]. In patients who sustain traumatic arterial injury to the lower extremities, timely intervention with rapid revascularization is key for limb salvage.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Repair of a Traumatic Popliteal Artery Injury

Nguyen¹,

Tiziano²,

Beckermann³

et al. 2022

Cureus

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In patients who sustain a traumatic arterial injury to the lower extremities, timely intervention is key for limb salvage. Traditionally, patients with a popliteal injury have undergone an open surgical bypass but, in recent years, endovascular repair has become more frequent. We present the case of a 46-year-old male who sustained a right tibial/fibular fracture and an associated popliteal artery injury during a pedestrian versus car accident. At presentation, distal signals were not detectable on duplex ultrasonography, and computed tomography confirmed an occlusion of the P3 popliteal artery and proximal anterior tibial and tibioperoneal trunk, as well as a comminuted tibia and fibula fracture. He also had a subdural hematoma without midline shift. He was taken to the operating room emergently and, following external fixation of the tibial/fibular fracture, he underwent angiography of the right leg. There was no thrombus or extravasation but a static column of blood secondary to a flow-limiting intimal flap was present, and an endovascular repair of the popliteal artery with balloon angioplasty and Tack stents (Intact Vascular, Wayne, PA) was pursued. Heparin was not utilized due to the patient's intracranial hemorrhage. On hospital day four, he underwent internal fixation of the tibial/fibular fracture. The subarachnoid/subdural hematoma remained stable and a prophylactic dose of rivaroxaban and aspirin was started. The patient recovered well from these procedures and was discharged 16 days after the accident.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endovascular Repair of a Traumatic Popliteal Artery Injury

Nguyen¹,

Tiziano²,

Beckermann³

et al. 2022

Cureus

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“…Keywords: Lower extremity trauma; Popliteal artery; Popliteal injury; Vascular trauma Traumatic popliteal vascular injuries present a serious clinical challenge, because they are associated with the highest risk of limb loss of all peripheral vascular injuries, with major amputation rates of 14% to 25% in the civilian population. [1][2][3][4] The amputation rate is high in part because of the association with mangled extremities, which represent a subset of these injuries. In 1988, Johansen et al, 5 at Harborview Medical Center, developed the mangled extremity severity score (MESS) in an effort to determine for which patients attempts at limb salvage would be futile.…”

Section: Discussionmentioning

confidence: 99%

Popliteal scoring assessment for vascular extremity injuries in trauma study

O’Banion

Dirks

Farooqui

et al. 2021

Journal of Vascular Surgery

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“…Non-operative treatment is definitely not recommended if popliteal artery injuries are significant and present with acutely ischemic limbs [ 5 ]. Although significantly reduced amputation rates for PAI have been achieved with improved revascularization technology, it is still a challenge for orthopedic surgeons mainly due to the heterogeneous patient populations with moderately to severely blunt PAI [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Five-year outcomes of trauma-specific function in patients after acute blunt popliteal artery injury: a matched cohort analysis

Liu

Zhou

2022

J Orthop Surg Res

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Background Few studies focus on the trauma-specific functional outcomes after surgical revascularization and risk factors contributing to poor outcomes in patients with acute blunt popliteal artery injury (PAI). The objective of this study was to investigate the long-term trauma-specific functional outcomes in patients with acute blunt PAI and identify the associated risk factors. Methods There were 36 patients with acute blunt PAI who require surgical revascularization at a national trauma center of West China Hospital of Sichuan University between March 2010 and April 2019. After propensity matching, each patient was matched to one patient who did not have a concomitant vascular injury in control cohort. Functional outcomes were assessed with trauma-specific functional scores, physical examination of range of motion, nerve functional status and knee stability. A logistics regression model was established to determine the independent risk factors. Results The 5-year (range 2–10 years) follow-up showed that 22 patients (22/36, 61.1%) had functional deficit due to limited activity or chronic neurological symptoms. Patients in vascular cohort had significantly decreased FIM score and AHFS score compared with matched patients without vascular involvement (P = 0.003 and P < 0.001), whereas there was no statistically significant difference in KSS (P = 0.136). Spearman correlation analysis of functional scores in vascular cohort showed that the FIM score was positively correlated with AHFS score (r = 0.926, P < 0.001), but not correlated with the KSS (r = − 0.007, P = 0.967). Additionally, there was significant difference in the range of motion of ankle between two groups (P < 0.001 and P = 0.034). Logistic regression analysis further demonstrated nerve injuries and compartment syndrome were risk factors for poor ankle function after surgery (OR 22.580, P = 0.036 and OR 12.674, P = 0.041). Conclusion Most patients who sustained blunt PAI had significant functional deficit associated with limited activity and chronic neurological symptoms of ankle and foot, and poor functional outcomes were related to nerve injury and compartment syndrome. Therefore, early and effective decompression for compartment syndrome remains the only potentially modifiable risk factor for improving functional outcomes following PAI.

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Endovascular versus open repair of isolated superficial femoral and popliteal artery injuries

Cited by 19 publications

References 30 publications

Endovascular Repair of a Traumatic Popliteal Artery Injury

Endovascular Repair of a Traumatic Popliteal Artery Injury

Popliteal scoring assessment for vascular extremity injuries in trauma study

Five-year outcomes of trauma-specific function in patients after acute blunt popliteal artery injury: a matched cohort analysis

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