Contemporary Management Of Popliteal Artery Injuries: Data From The Proovit Registry
Joseph J. DuBose, MD1, Jonathan Morrison, MD1, Krisofer Charlton-Ouw, MD2, Tiffany Bee, MD3, Thomas M. Scalea, MD1, Todd E. Rasmussen, MD4, David Feliciano, MD1.
1University of Maryland, Baltimore, MD, USA, 2University of Houston, Houston, TX, USA, 3University of Tennessee - Memphis, Memphis, TN, USA, 4Uniformed Services University of the Health Sciences, Washington, DC, DC, USA.
OBJECTIVES: Optimal management of popliteal artery injuries remain a challenge of modern trauma care, even as diagnostic and therapeutic capabilities continue to evolve. METHODS: The PROOVIT Registry was utilized to identify popliteal artery injuries presenting to 28 ACS Level 1 and 2 trauma centers from February 2013, to December 2019. Demographics, management and outcomes were analyzed.
RESULTS: 242 patients with popliteal artery injuries were identified. Median age was 32.0 yrs, 82.6% were male. Mechanisms included blunt (58.7%), penetrating (36.4%) and mixed (5.0%). Pre-hospital tourniquets were employed in 19.0%. Injury diagnosis and characterization was achieved using operative exploration (57.9%) CTA (47.5%), conventional angiography (10.8%) and duplex ultrasound (3.7%). The most common injury types observed were transection (49.2%) and occlusion (34.7%). Non-operative management was initially employed in 8.3% (20/242), with one in-hospital death and requirement for delayed intervention in 20% (4/20; 2 salvage open repairs, 2 amputations). Initial endovascular intervention was undertaken in 4.1% (10/242), including stent deployment (8), catheter thrombectomy (1) and embolization prior to subsequent open interposition graft placement (1). One failure of planned definitive endovascular repair required a secondary endovascular salvage procedure. Open intervention was employed in 87.6% (212/242), including primary repair (12.7%; 27) and insertion of an interposition graft (64.4% ; 156). Fasciotomies in the leg were performed in 72.6% of open procedures, with 3 patients requiring a fasciotomy at later operation (1.4%). There were no statistically significant differences in demographics, presentation or complications between open / endovascular groups. The need for re-intervention after all forms of management was 19.4% (47/242). Amputation after attempted limb salvage was required in 16.5%, and overall mortality was 2.9%. CONCLUSIONS: Popliteal artery injuries remain a challenge of modern trauma care associated with an appreciable amputation rate. Endovascular management is utilized sparingly but with comparable outcomes, although likely in the presence of very select circumstances not discernable from registry review.
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