Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Endovascular Repair of Blunt Popliteal Arterial Injuries

  • Zhong, Shan (Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army) ;
  • Zhang, Xiquan (Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army) ;
  • Chen, Zhong (Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army) ;
  • Dong, Peng (Department of Medical Imaging, Weifang Medical University) ;
  • Sun, Yequan (Department of Medical Imaging, Weifang Medical University) ;
  • Zhu, Wei (Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army) ;
  • Pan, Xiaolin (Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army) ;
  • Qi, Deming (Department of Medical Imaging, Qilu Medical University)
  • Received : 2016.05.18
  • Accepted : 2016.06.05
  • Published : 2016.09.01
⟨ Previous Next ⟩

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 $35.9{\pm}10.3$ 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 $20.9{\pm}2.3$ 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.

Keywords

References

  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 https://doi.org/10.1016/j.jvs.2006.02.052
  2. Lang NW, Joestl JB, Platzer P. Characteristics and clinical outcome in patients after popliteal artery injury. J Vasc Surg 2015;61:1495-1500 https://doi.org/10.1016/j.jvs.2015.01.045
  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 https://doi.org/10.1016/j.amjsurg.2006.08.043
  4. Frykberg ER. Popliteal vascular injuries. Surg Clin North Am 2002;82:67-89 https://doi.org/10.1016/S0039-6109(03)00141-5
  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 https://doi.org/10.5435/00124635-201108000-00005
  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 https://doi.org/10.1007/s00068-012-0217-7
  7. Scalea TM, Sclafani S. Interventional techniques in vascular trauma. Surg Clin North Am 2001;81:1281-1297, xii https://doi.org/10.1016/S0039-6109(01)80008-6
  8. Carrafiello G, Lagana 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 https://doi.org/10.1016/j.jvir.2010.09.015
  9. Onal B, Ilgit ET, Kosar S, Akkan K, Gumus 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-Ane C, et al. Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery. Eur J Vasc Endovasc Surg 2011;42:167-171 https://doi.org/10.1016/j.ejvs.2011.04.011
  11. Canaud L, Marty-Ane 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 https://doi.org/10.1016/j.jtcvs.2014.10.113
  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 https://doi.org/10.1016/j.jvs.2014.05.028
  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 https://doi.org/10.1016/j.jvs.2014.05.016
  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 https://doi.org/10.1016/j.jvs.2007.11.009
  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 https://doi.org/10.1016/j.injury.2016.02.003
  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 https://doi.org/10.1016/j.avsg.2014.10.017
  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 https://doi.org/10.1067/mva.2001.113982
  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 https://doi.org/10.1097/00000658-194604000-00005
  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 https://doi.org/10.1016/j.avsg.2013.06.017
  21. Wolma FJ, Larrieu AJ, Alsop GC. Arterial injuries of the legs associated with fractures and dislocations. Am J Surg 1980;140:806-809 https://doi.org/10.1016/0002-9610(80)90122-1
  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 https://doi.org/10.1016/j.avsg.2012.09.011
  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 https://doi.org/10.1177/1538574411409065
  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 https://doi.org/10.1177/0363546507311595
  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 https://doi.org/10.1016/S1051-0443(91)72286-0
  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 https://doi.org/10.1016/j.ijsu.2015.04.056
  28. Hutto JD, Reed AB. Endovascular repair of an acute blunt popliteal artery injury. J Vasc Surg 2007;45:188-190 https://doi.org/10.1016/j.jvs.2006.08.067
  29. Cervin A, Tjarnstrom 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 https://doi.org/10.1016/j.ejvs.2015.03.026
  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 https://doi.org/10.1097/MD.0000000000001130
  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 https://doi.org/10.3348/kjr.2015.16.4.696
  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 https://doi.org/10.3348/kjr.2011.12.2.203
  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 https://doi.org/10.1016/j.jvs.2005.04.049
  34. Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Caronno R, Lagana D, et al. Endovascular treatment for traumatic injuries of the peripheral arteries following blunt trauma. Injury 2007;38:1091-1097 https://doi.org/10.1016/j.injury.2007.02.044
  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 https://doi.org/10.1016/j.jvs.2008.02.029
  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 https://doi.org/10.1097/00005373-200111000-00012
  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 https://doi.org/10.1583/JEVT-12-3930MR2.1
  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 https://doi.org/10.1007/s00270-013-0639-6
  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 https://doi.org/10.1016/S0002-9610(94)80041-3
  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 https://doi.org/10.1002/bjs.1800811012
  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 https://doi.org/10.1148/radiology.201.3.8939221
  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 https://doi.org/10.1097/01.RVI.0000194866.31834.E4
  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

Cited by

  1. Diagnostic workup and endovascular treatment of popliteal artery trauma vol.48, pp.1, 2019, https://doi.org/10.1024/0301-1526/a000756
  2. Endovascular Therapy of Vascular Trauma-Current Options and Review of the Literature vol.53, pp.6, 2016, https://doi.org/10.1177/1538574419844073
  3. Endovascular versus open repair of isolated superficial femoral and popliteal artery injuries vol.74, pp.3, 2016, https://doi.org/10.1016/j.jvs.2021.02.023