OBJECTIVE: Traumatic popliteal artery injuries are associated with the highest risk of limb loss of all peripheral vascular injuries, with amputation rates of 10-15%. The purpose of this study was to examine outcomes of patients undergoing operative repair for traumatic popliteal arterial injuries and identify factors independently associated with limb loss.METHODS: A multi-institutional retrospective review of all patients sustaining traumatic popliteal artery injuries from 2007-2018 was performed. All patients who had operative repair of popliteal arterial injuries were included in the analysis. Patients undergoing major lower extremity amputation (trans-tibial or trans-femoral) were compared to those with successful limb salvage at last follow-up. Significant predictors (p<0.05) for amputation on univariate analysis were included in a multivariable analysis.RESULTS: A total of 302 patients from 11 institutions were included in the analysis. Median age was 32 [IQR: 21-40] years and 79% were male. Median follow-up was 72 days [IQR: 20 - 366]. Overall major amputation rate was 13%. Primary repair was performed in 17% of patients, patch repair in 2%, and interposition/bypass in 81%. One patient underwent endovascular repair with stenting. Overall 1-year primary patency was 89%. Of patients that lost primary patency, 46% ultimately required major amputation. Early loss (within 30 days post-op) of primary patency was 5 times more frequent in patients that went on to amputation. On multivariate regression, significant perioperative factors independently associated with major amputation included: initial POPSAVEIT score, loss of primary patency, absence of detectable immediate postoperative pedal Doppler signals, and lack of postoperative antiplatelet therapy. Concomitant popliteal vein injury, location of popliteal injury (P1, P2, P3), ISS, and tibial vs. popliteal distal bypass target were not independently associated with amputation.CONCLUSION: Traumatic popliteal artery injuries are associated with a significant rate of major amputation. Preoperative POPSAVEIT score remains independently associated with amputation after including perioperative factors. Lack of postoperative pedal Doppler signals and loss of primary patency were highly associated with major amputation. Postoperative antiplatelet therapy is inversely associated with amputation, perhaps indicating a protective effect.
View details for DOI 10.1016/j.jvs.2021.04.064
View details for PubMedID 34023429