Outcomes and Predictors of Popliteal Artery Injury in Pediatric Trauma

Maithel, Shelley; Fujitani, Roy M.; Grigorian, Areg; Kabutey, Nii-Kabu; Gambhir, Sahil; Sheehan, Brian; Nahmias, Jeffry

doi:10.1016/j.avsg.2020.01.079

Cited by 3 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These injuries are difficult to manage, and limited data is available due to their rare incidence [ 12 ]. The most common methods of treatment in pediatric patients suffering PAI were via open procedures (62.1%), followed by nonoperative (36.2%) and endovascular-type procedures (10%) [ 3 ]. Our patient received an open bypass procedure.…”

Section: Discussionmentioning

confidence: 99%

“…This can result in increased time to diagnosis which puts lower extremity tissue at ischemic risk. 3 Collateral blood flow from the popliteal artery is often limited which causes a PAI to be a very severe limb-threatening injury [3]. PAI is associated with an alarming rate of above-and below-the-knee amputations, accounting for 3-10% of cases [3,11].…”

Section: Discussionmentioning

confidence: 99%

“…3 Collateral blood flow from the popliteal artery is often limited which causes a PAI to be a very severe limb-threatening injury [3]. PAI is associated with an alarming rate of above-and below-the-knee amputations, accounting for 3-10% of cases [3,11]. This increase in severity is due to the pediatrics population increased likelihood of sustaining a physis injury, rather than a simple ligamentous injury after trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Popliteal artery injuries can accompany adolescent lower extremity fractures. Maithel et al noted significantly increased odds of developing PAI following fractures of tibia, fibula, femur, and patella in comparison to other lower extremity trauma [ 3 ]. Vascular injuries in the setting of pediatric trauma are relatively rare, accounting for between 0.6 and 1.4% of injuries [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Of those instances of trauma-related vascular injuries, only 5% of those are PAI [ 2 , 5 ]. PAI is most commonly secondary to blunt and penetrating trauma to the lower extremity [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Delayed Presentation of Popliteal Artery Injury after Salter-Harris III Proximal Tibia Fracture

Seidenstein,

Torrez,

Garcia

et al. 2023

Case Reports in Orthopedics

View full text Add to dashboard Cite

Introduction. Proximal tibia physeal fractures in children are not very common but can be dangerous because they can harm popliteal fossa structures, especially the popliteal artery. Popliteal artery injuries (PAI) are most commonly the result of trauma to the lower extremity, including blunt force, hyperextension injuries, complex fractures, and knee dislocations that can compromise popliteal neurovascular structures. Case Presentation. A 14-year-old boy presents to the emergency department after being transferred from an outside hospital 24 hours after a left lower extremity hyperextension injury. Radiographs demonstrated a Salter-Harris III proximal tibia fracture with posterior displacement. ABIs were deferred due to palpable distal pulses and no evidence of compartment syndrome. Closed reduction and percutaneous pinning were planned to correct the fracture. Intraoperatively, it was discovered that knee extension decreased lower extremity perfusion while knee flexion returned perfusion. An angiography revealed a popliteal artery occlusion with no distal flow. Based on this, an above-knee to below-knee popliteal bypass using the contralateral great saphenous vein was performed followed by closed reduction and percutaneous pinning of the proximal tibia. Conclusion. Proximal tibia physeal injuries, especially the Salter-Harris III and IV injuries, warrant a high index of suspicion of popliteal artery injuries. Palpable pulses and delayed presentation in the distal lower extremity do not rule out a PAI because collateral flow to the anterior and posterior tibial arteries may mask signs of an avascular limb, highlighting the need for a thorough history and physical exam. The authors present this case to reaffirm the importance of an ankle-brachial index when evaluating hyperextension injuries with proximal tibial epiphyseal fractures.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Of those instances of trauma-related vascular injuries, only 5% of those are PAI [ 2 , 5 ]. PAI is most commonly secondary to blunt and penetrating trauma to the lower extremity [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Delayed Presentation of Popliteal Artery Injury after Salter-Harris III Proximal Tibia Fracture

Seidenstein,

Torrez,

Garcia

et al. 2023

Case Reports in Orthopedics

View full text Add to dashboard Cite

show abstract

Therapeutic management and amputation options in a long time delayed blunt popliteal artery injury

Qiu

Cheng

Wang

et al. 2023

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Systematic review and meta-analysis of endovascular therapy versus open surgical repair for the traumatic lower extremity arterial injury

Qi,

Wang,

Yuan

et al. 2024

World J Emerg Surg

View full text Add to dashboard Cite

Objective For traumatic lower extremity artery injury, it is unclear whether it is better to perform endovascular therapy (ET) or open surgical repair (OSR). This study aimed to compare the clinical outcomes of ET versus OSR for traumatic lower extremity artery injury. Methods The Medline, Embase, and Cochrane Databases were searched for studies. Cohort studies and case series reporting outcomes of ET or OSR were eligible for inclusion. Robins-I tool and an 18-item tool were used to assess the risk of bias. The primary outcome was amputation. The secondary outcomes included fasciotomy or compartment syndrome, mortality, length of stay and lower extremity nerve injury. We used the random effects model to calculate pooled estimates. Results A total of 32 studies with low or moderate risk of bias were included in the meta-analysis. The results showed that patients who underwent ET had a significantly decreased risk of major amputation (OR = 0.42, 95% CI 0.21–0.85; I2=34%) and fasciotomy or compartment syndrome (OR = 0.31, 95% CI 0.20–0.50, I2 = 14%) than patients who underwent OSR. No significant difference was observed between the two groups regarding all-cause mortality (OR = 1.11, 95% CI 0.75–1.64, I2 = 31%). Patients with ET repair had a shorter length of stay than patients with OSR repair (MD=-5.06, 95% CI -6.76 to -3.36, I2 = 65%). Intraoperative nerve injury was just reported in OSR patients with a pooled incidence of 15% (95% CI 6%–27%). Conclusion Endovascular therapy may represent a better choice for patients with traumatic lower extremity arterial injury, because it can provide lower risks of amputation, fasciotomy or compartment syndrome, and nerve injury, as well as shorter length of stay.

show abstract

Outcomes and Predictors of Popliteal Artery Injury in Pediatric Trauma

Cited by 3 publications

References 24 publications

Delayed Presentation of Popliteal Artery Injury after Salter-Harris III Proximal Tibia Fracture

Delayed Presentation of Popliteal Artery Injury after Salter-Harris III Proximal Tibia Fracture

Therapeutic management and amputation options in a long time delayed blunt popliteal artery injury

Systematic review and meta-analysis of endovascular therapy versus open surgical repair for the traumatic lower extremity arterial injury

Contact Info

Product

Resources

About