Musonza Tashinga, Khouqueer Ahmed, Gilani Ramyar
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States of America.
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States of America.
Trauma Case Rep. 2019 Jul 29;23:100230. doi: 10.1016/j.tcr.2019.100230. eCollection 2019 Oct.
Popliteal artery trauma is reported to have the highest rates of limb loss in peripheral vascular injuries. It can be inferred that morbidity associated with bilateral popliteal artery trauma is worse. However, bilateral popliteal artery injuries are sparsely reported in literature and as such management options are not well defined. Despite the paucity of reported cases, a systematic and deliberate approach to these devastating injuries may result in reproducible limb salvage. We hereby use our case report as a provocateur to this conundrum. Consideration should be given to the utilization of surgical shunts or a two-surgical team and limb salvage attempted till proving the neurovascular bundle irreparable. Arterial grafts should be part of the surgeon's armamentarium. In massive hard to control hemorrhage, tourniquets or resuscitative endovascular occlusion devices (REBOA) may prove lifesaving. Larger studies are needed to define contemporary management and derive management guidelines.
据报道，在周围血管损伤中，腘动脉创伤导致肢体丧失的发生率最高。可以推断，双侧腘动脉创伤相关的发病率更高。然而，双侧腘动脉损伤在文献中报道较少，因此治疗方案尚不明确。尽管报道的病例很少，但对这些严重损伤采取系统、审慎的方法可能会实现可重复的肢体挽救。我们在此将我们的病例报告作为引发这一难题讨论的契机。应考虑使用手术分流器或两个手术团队，并尝试进行肢体挽救，直到证明神经血管束无法修复。动脉移植物应是外科医生的必备工具之一。在难以控制的大量出血中，止血带或复苏性血管内闭塞装置（REBOA）可能被证明能挽救生命。需要进行更大规模的研究来确定当代治疗方法并制定治疗指南。
