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

Endovascular Repair of Blunt Popliteal Arterial Injuries

Affiliations
  • 1Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army, Zibo 255300, P.R.China. zyfbb19901024@sina.com
  • 2Department of Medical Imaging, Weifang Medical University, Weifang 261053, P.R.China.
  • 3Department of Medical Imaging, Qilu Medical University, Zibo 255200, P.R.China.

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.


Reference

1. Mullenix PS, Steele SR, Andersen CA, Starnes BW, Salim A, Martin MJ. Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank. J Vasc Surg. 2006; 44:94–100.
2. Lang NW, Joestl JB, Platzer P. Characteristics and clinical outcome in patients after popliteal artery injury. J Vasc Surg. 2015; 61:1495–1500.
3. Huynh TT, Pham M, Griffin LW, Villa MA, Przybyla JA, Torres RH, et al. Management of distal femoral and popliteal arterial injuries: an update. Am J Surg. 2006; 192:773–778.
4. Frykberg ER. Popliteal vascular injuries. Surg Clin North Am. 2002; 82:67–89.
5. Halvorson JJ, Anz A, Langfitt M, Deonanan JK, Scott A, Teasdall RD, et al. Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg. 2011; 19:495–504.
6. Sciarretta JD, Perez-Alonso AJ, Ebler DJ, Mazzini FN, Petrone P, Asensio-Gonzalez JA. Popliteal vessel injuries: complex anatomy, difficult problems and surgical challenges. Eur J Trauma Emerg Surg. 2012; 38:373–391.
7. Scalea TM, Sclafani S. Interventional techniques in vascular trauma. Surg Clin North Am. 2001; 81:1281–1297. xii
8. Carrafiello G, Laganà D, Mangini M, Fontana F, Chiara R, Filippo P, et al. Percutaneous treatment of traumatic upper-extremity arterial injuries: a single-center experience. J Vasc Interv Radiol. 2011; 22:34–39.
9. Onal B, Ilgit ET, Koşar S, Akkan K, Gümüş T, Akpek S. Endovascular treatment of peripheral vascular lesions with stent-grafts. Diagn Interv Radiol. 2005; 11:170–174.
10. Canaud L, Hireche K, Joyeux F, D'Annoville T, Berthet JP, Marty-Ané C, et al. Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery. Eur J Vasc Endovasc Surg. 2011; 42:167–171.
11. Canaud L, Marty-Ané C, Ziza V, Branchereau P, Alric P. Minimum 10-year follow-up of endovascular repair for acute traumatic transection of the thoracic aorta. J Thorac Cardiovasc Surg. 2015; 149:825–829.
12. Branco BC, DuBose JJ, Zhan LX, Hughes JD, Goshima KR, Rhee P, et al. Trends and outcomes of endovascular therapy in the management of civilian vascular injuries. J Vasc Surg. 2014; 60:1297–1307. 1307.e1
13. Desai SS, DuBose JJ, Parham CS, Charlton-Ouw KM, Valdes J, Estrera AL, et al. Outcomes after endovascular repair of arterial trauma. J Vasc Surg. 2014; 60:1309–1314.
14. du Toit DF, Lambrechts AV, Stark H, Warren BL. Long-term results of stent graft treatment of subclavian artery injuries: management of choice for stable patients? J Vasc Surg. 2008; 47:739–743.
15. Matsagkas M, Kouvelos G, Peroulis M, Xanthopoulos D, Bouris V, Arnaoutoglou E. Endovascular repair of blunt axillo-subclavian arterial injuries as the first line treatment. Injury. 2016; 47:1051–1056.
16. Trellopoulos G, Georgiadis GS, Aslanidou EA, Nikolopoulos ES, Pitta X, Papachristodoulou A, et al. Endovascular management of peripheral arterial trauma in patients presenting in hemorrhagic shock. J Cardiovasc Surg (Torino). 2012; 53:495–506.
17. Macedo FI, Sciarretta JD, Salsamendi J, Karmacharya J, Romano A, Namias N. Repair of an acute blunt popliteal artery trauma via endovascular approach. Ann Vasc Surg. 2015; 29:366.e5–366.e10.
18. Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 2001; 33:1212–1219.
19. Debakey ME, Simeone FA. Battle injuries of the arteries in world war II: an analysis of 2,471 cases. Ann Surg. 1946; 123:534–579.
20. Dua A, Desai SS, Shah JO, Lasky RE, Charlton-Ouw KM, Azizzadeh A, et al. Outcome predictors of limb salvage in traumatic popliteal artery injury. Ann Vasc Surg. 2014; 28:108–114.
21. Wolma FJ, Larrieu AJ, Alsop GC. Arterial injuries of the legs associated with fractures and dislocations. Am J Surg. 1980; 140:806–809.
22. McArthur CS, Marin ML. Endovascular therapy for the treatment of arterial trauma. Mt Sinai J Med. 2004; 71:4–11.
23. Rocha L, Dalio MB, Joviliano EE, Piccinato CE. Endovascular approach for peripheral arterial injuries. Ann Vasc Surg. 2013; 27:587–593.
24. Kropman RH, Kiela G, Moll FL, de Vries JP. Variations in anatomy of the popliteal artery and its side branches. Vasc Endovascular Surg. 2011; 45:536–540.
25. Klecker RJ, Winalski CS, Aliabadi P, Minas T. The aberrant anterior tibial artery: magnetic resonance appearance, prevalence, and surgical implications. Am J Sports Med. 2008; 36:720–727.
26. Becker GJ, Benenati JF, Zemel G, Sallee DS, Suarez CA, Roeren TK, et al. Percutaneous placement of a balloon-expandable intraluminal graft for life-threatening subclavian arterial hemorrhage. J Vasc Interv Radiol. 1991; 2:225–229.
27. Sciarretta JD, Macedo FI, Otero CA, Figueroa JN, Pizano LR, Namias N. Management of traumatic popliteal vascular injuries in a level I trauma center: a 6-year experience. Int J Surg. 2015; 18:136–141.
28. Hutto JD, Reed AB. Endovascular repair of an acute blunt popliteal artery injury. J Vasc Surg. 2007; 45:188–190.
29. Cervin A, Tjärnström J, Ravn H, Acosta S, Hultgren R, Welander M, et al. Treatment of popliteal aneurysm by open and endovascular surgery: a contemporary study of 592 procedures in Sweden. Eur J Vasc Endovasc Surg. 2015; 50:342–350.
30. Ronchey S, Pecoraro F, Alberti V, Serrao E, Orrico M, Lachat M, et al. Popliteal artery aneurysm repair in the endovascular era: fourteen-years single center experience. Medicine (Baltimore). 2015; 94:e1130.
31. Kim YH, Bae JI, Jeon YS, Kim CW, Jae HJ, Park KB, et al. Korean guidelines for interventional recanalization of lower extremity arteries. Korean J Radiol. 2015; 16:696–722.
32. Chang IS, Chee HK, Park SW, Yun IJ, Hwang JJ, Lee SA, et al. The primary patency and fracture rates of self-expandable nitinol stents placed in the popliteal arteries, especially in the P2 and P3 segments, in Korean patients. Korean J Radiol. 2011; 12:203–209.
33. Antonello M, Frigatti P, Battocchio P, Lepidi S, Cognolato D, Dall'Antonia A, et al. Open repair versus endovascular treatment for asymptomatic popliteal artery aneurysm: results of a prospective randomized study. J Vasc Surg. 2005; 42:185–193.
34. Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Caronno R, Laganà D, et al. Endovascular treatment for traumatic injuries of the peripheral arteries following blunt trauma. Injury. 2007; 38:1091–1097.
35. Nikanorov A, Smouse HB, Osman K, Bialas M, Shrivastava S, Schwartz LB. Fracture of self-expanding nitinol stents stressed in vitro under simulated intravascular conditions. J Vasc Surg. 2008; 48:435–440.
36. Brandt MM, Kazanjian S, Wahl WL. The utility of endovascular stents in the treatment of blunt arterial injuries. J Trauma. 2001; 51:901–905.
37. Ruffino MA, Rabbia C. Italian Cardiatis Registry Investigators Group. Endovascular repair of peripheral and visceral aneurysms with the Cardiatis multilayer flow modulator: one-year results from the Italian Multicenter Registry. J Endovasc Ther. 2012; 19:599–610.
38. Pieper CC, Meyer C, Rudolph J, Verrel F, Schild HH, Wilhelm KE. Interventional exclusion of iliac artery aneurysms using the flow-diverting multilayer stent. Cardiovasc Intervent Radiol. 2013; 36:917–925.
39. Chalmers RT, Hoballah JJ, Sharp WJ, Kresowik TF, Corson JD. The effect of an intraluminal stent on neointimal hyperplasia at an end-to-side polytetrafluoroethylene graft arterial anastomosis. Am J Surg. 1994; 168:85–90.
40. Chalmers RT, Hoballah JJ, Sharp WJ, Kresowik TF, Corson JD. Effect of an endovascular stent on healing of an end-to-end polytetrafluoroethylene-artery anastomosis in a canine model. Br J Surg. 1994; 81:1443–1447.
41. Henry M, Amor M, Cragg A, Porte JM, Henry I, Amicabile C, et al. Occlusive and aneurysmal peripheral arterial disease: assessment of a stent-graft system. Radiology. 1996; 201:717–724.
42. Resnick S, Chiang A. Transcatheter embolization of a high-flow renal arteriovenous fistula with use of a constrained wallstent to prevent coil migration. J Vasc Interv Radiol. 2006; 17(2 Pt 1):363–367.
43. Yu PT, Rice-Townsend S, Naheedy J, Almodavar H, Mooney DP. Delayed presentation of traumatic infrapopliteal arteriovenous fistula and pseudoaneursym in a 10-year-old boy managed by coil embolization. J Pediatr Surg. 2012; 47:e7–e10.
Full Text Links
  • KJR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr