Original Articles
Popliteal artery injuries: Civilian experience with sixty-three patients during a twenty-four year period (1960 through 1984)*

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Abstract

Our experience with 63 patients who had popliteal artery injuries sustained in civilian accidents is reported. Blunt injuries occurred in 53 patients and 49 had associated skeletal injuries. Eighteen patients suffered knee dislocation; six of these patients had associated fractures. Fractures of the upper third of the tibia occurred in 21 patients. Five patients had irreversible ischemia and required primary amputation. Thirteen amputations were required in 58 patients in whom arterial repair was performed, for an amputation rate of 22%. There were no amputations in 19 patients treated less than 6 hours after injury was sustained. Four deaths occurred. Fasciotomy was performed in 20 patients. Skeletal injuries were usually treated with external fixation. (J VASC SURG 1986;4:55-62.)

Section snippets

Patients

Sixty-three patients with injuries of the popliteal artery were admitted to the Health Sciences Centre (formerly Winnipeg General Hospital) during the past 24 years. The study comprised 53 male and 10 female patients, ranging in age from 10 to 73 years with 82% between 10 and 40 years of age. Fifty-three patients sustained blunt injuries and 10 patients suffered penetrating injuries (Table I).

. Mechanism of arterial injury

Empty CellNo.%
Blunt with skeletal lesion4470
Blunt without skeletal lesion914

Associated skeletal injury

Skeletal trauma accompanied the arterial injury in 49 of the 63 patients (Table III).

. Associated skeletal injury and incidence of amputation

Empty CellNo.Amputation%
Knee dislocation12433
Knee dislocation with femoral shaft fracture1
Knee dislocation with femoral and tibial shaft fractures11
Knee dislocation with tibial plateau and fibular fractures3
Knee dislocation with fracture fibula11
Upper tibia and fibula fractures20945
Upper tibia and fibula with femoral shaft fractures2
Femoral supracondylar

Repair and results

Four patients died, resulting in a mortality rate of 6.3% (Table V).

. Results of repair

Empty CellNo.OcclusionsAmputationsDeathsDeaths
Direct anastomosis19002
Vein graft355111
Prosthesis3121
Lateral repair1
No repair55
 Total636184
All four patients had patent repairs with viable extremities. Three patients died of associated head injuries and a 73-year-old woman died of renal failure after successful revascularization of a severely ischemic limb 19 hours after injury. Eighteen of 63 patients required

Discussion

Popliteal artery occlusions associated with skeletal trauma caused by blunt injury continue to result in serious morbidity and high amputation rates. Delayed recognition of the arterial lesion is the major cause of these poor results. Our series includes 18 knee dislocations, most of which were reduced before the patient was admitted to the hospital. The magnitude of the injury and the potential for vascular disruption is frequently not suspected at the initial examination. This failure to

Summary

Our experience with 63 popliteal artery injuries has been reviewed. The single most important factor in successful management is early recognition and early repair. When repair is accomplished within 6 hours, the results are as good as those achieved with other arterial injuries. Dislocation of the knee is more common than frequently reported. Capillary-skin blood flow is not a reliable method of assessing the adequacy of the circulation. When a popliteal artery injury is suspected, it must be

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*

Reprint requests: A. R. Downs, M.D., F.R.C.S.C., Department of Surgery, University of Manitoba and Health Sciences Centre, 700 William Ave., Winnipeg, Manitoba, Canada R3E 0Z3.

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