Korean J Radiol.  2016 Oct;17(5):789-796. 10.3348/kjr.2016.17.5.789.

Endovascular Repair of Blunt Popliteal Arterial Injuries

• Zhong S
• Zhang X
• Chen Z
• Dong P
• Sun Y
• Zhu W
• Pan X
• Qi D

• KMID: 2458072
• DOI: http://doi.org/10.3348/kjr.2016.17.5.789

Abstract

OBJECTIVE
To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries.
MATERIALS AND METHODS
A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries.
RESULTS
Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18-24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up.
CONCLUSION
Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.

Keyword

Blunt popliteal arterial injuries; Endovascular repair; Limb salvage; Interventional radiology

MeSH Terms

Adult
Aneurysm, False/diagnostic imaging/surgery
Angiography
Angioplasty, Balloon/methods
Endovascular Procedures/*methods
Feasibility Studies
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Popliteal Artery/diagnostic imaging/*injuries/surgery
Retrospective Studies
Stents
Time Factors
Treatment Outcome
Vascular System Injuries/diagnostic imaging/etiology/*surgery
Wounds, Nonpenetrating/diagnostic imaging/etiology/*surgery
Young Adult

Figure

• 

  Fig. 1 Old arteriovenous fistula of right popliteal artery. A. Selective angiography of right popliteal artery shows arteriovenous fistula. B. Angiography was performed to assess fistula after bare stent (6 mm × 4 cm) implantation. Coils were implanted to fistula through mesh of stent. C, D. Disappearance of arteriovenous fistula was confirmed by angiography.

• 

  Fig. 2 Transection of right popliteal artery. A. Selective angiography shows transection of right popliteal artery and proximal end of right popliteal artery was blocked by hematomas. B. Angiography was performed after deployment of two stents (6 mm × 15 cm) with through-and-through wire access.

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