Elsevier

Injury

Volume 32, Issue 5, June 2001, Pages 357-361
Injury

Popliteal artery trauma: A critical appraisal of an uncommon injury

https://doi.org/10.1016/S0020-1383(01)00007-9Get rights and content

Abstract

Although popliteal artery injuries are uncommon, the consequent lack of management protocols may contribute to an already high level of outcome morbidity. We critically reviewed all nine cases of popliteal artery trauma treated at our institution in the last 5 years. The main findings were that blunt trauma was predominant and most patients presented with severe signs of ischaemia. Long delays occurred between injury and treatment, mostly due to the tyranny of distance. Nevertheless, most patients were subjected to further delay whilst undergoing unnecessary formal angiography. Interposition vein graft using contralateral long saphenous vein was the predominant procedure for arterial injury. Most patients did not receive systemic anticoagulation or fasciotomy, and none received intra-operative thrombolysis. Our limb salvage rate was 7/9, although two of these had persistent neurological disability. We criticise our shortcomings in the light of the current literature.

Introduction

Injuries to the popliteal artery are uncommon, but have been associated with poor rates of limb salvage, as well as high levels of morbidity [1], [2], [3], [4], [5], [6]. This is most common in blunt trauma, where these sequelae are frequently the result of severe skeletal and soft tissue injuries [7]. The Royal Perth Hospital (RPH) is the largest provider of rural trauma services in the state and the second largest trauma provider in Australia. We reviewed our experience of this injury over the past 5 years and discussed a plan of management based on the findings and a review of the literature.

Section snippets

Patients and methods

Records of all individuals, who presented to the RPH and had a popliteal arterial injury between August 1994 and January 2000 were collected from the prospective trauma database maintained at the RPH. This database records all trauma patients admitted to the RPH for greater than 24 h and those who died in the emergency department (ED). The data does not include those dying at the scene and in transit to RPH. Also not included are individuals under the age of 16, as the RPH only treats adult

Results

Nine patients [all male, median age 34 (17–62)] sustained a popliteal artery injury between August 1994 and January 2000. Eight cases were due to blunt trauma. The causes of injury are shown in Table 2. Demographic and clinical data are summarised in Table 3.

Most patients underwent arteriography (n=7) with the X-ray suite being the commonest venue (5/7 arteriograms). Systemic heparin (100 IU/kg) was administered in only 3/7 patients prior to clamping of the popliteal artery. Compartmental

Discussion

There is considerable disparity in the cause of popliteal artery injury from different parts of the world. In USA, penetrating trauma and gunshot wounds in particular have been shown to be the predominant cause in most studies, accounting for 30–80% of all injuries [5], [6], [10], [11], [12]. A recent study from Durban, South Africa has shown penetrating trauma (again predominantly gunshot) to be responsible for just over half (135/260 patients) of the cases [13]. Our experience mirrors that

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