Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, Wash.
J Vasc Surg. 2021 Jun;73(6):2064-2070. doi: 10.1016/j.jvs.2020.12.050. Epub 2021 Mar 1.
The effectiveness of endovascular treatment for popliteal arterial injury has not been well-documented. This study was aimed to investigate the midterm outcomes of endovascular repair of traumatic isolated popliteal arterial injury.
Medical records of the patients who underwent endovascular repair for traumatic popliteal arterial injuries from January 2012 to February 2020 were reviewed retrospectively. Clinical data including patient demographics, Injury Severity Score, type of injury, classification of acute limb ischemia, concomitant extremity fracture, runoff vessel status, complications, time of endovascular procedure, time interval from injury to blood flow restoration, length of hospital stay, reintervention, and follow-up were collected and analyzed.
Endovascular repair was performed in 46 patients with traumatic popliteal arterial injuries. The mean Injury Severity Score was 15.8 ± 6.2. The overall limb salvage rate was 89.1%. There were 10 penetrating and 36 blunt injuries (78.3%). The initial angiographic findings revealed occlusion in 34 patients (73.9%), pseudoaneurysm in 2 (4.4%), active extravasation in 9 (19.5%), and arteriovenous fistulas in 1 (2.2%). Technical success was achieved in all 46 patients, via antegrade access in 24 patients (52.2%) and concurrent retrograde access in 22 (47.8%). The mean time interval from popliteal artery injury to blood flow restoration was 10.6 ± 4.9 hours and mean operative time was of 54.9 ± 10.0 minutes. The mean follow-up was 36.1 ± 14.5 months. The primary patency rate was 75.3% at 12 months, 61.9% at 24 months, and 55.7% at 48 months. The secondary patency rate was 92.2% at 12 and 24 months and 85.2% at 48 months. A Cox multivariate analysis revealed that single vessel runoff was an independent risk factor for primary patency loss.
Endovascular repair of an isolated popliteal artery injury may be a safe and effective alternative treatment in select patients, with acceptable midterm outcomes. Single vessel runoff was an independent risk factor for primary patency loss.
腘动脉损伤的血管内治疗效果尚未得到充分证实。本研究旨在探讨创伤性孤立性腘动脉损伤的血管内修复的中期结果。
回顾性分析 2012 年 1 月至 2020 年 2 月期间接受血管内修复创伤性腘动脉损伤的患者的病历。收集并分析患者的临床数据，包括患者人口统计学、损伤严重程度评分、损伤类型、急性肢体缺血分类、伴发肢体骨折、流出道血管状态、并发症、血管内操作时间、从损伤到血流恢复的时间间隔、住院时间、再次干预和随访情况。
46 例创伤性腘动脉损伤患者行血管内修复。平均损伤严重程度评分为 15.8±6.2。肢体总存活率为 89.1%。10 例为穿透伤，36 例为钝伤（78.3%）。初始血管造影发现 34 例（73.9%）动脉闭塞，2 例（4.4%）假性动脉瘤，9 例（19.5%）动脉外渗，1 例（2.2%）动静脉瘘。46 例患者均成功实现技术上的血管再通，其中经顺行入路 24 例（52.2%），同时行逆行入路 22 例（47.8%）。从腘动脉损伤到血流恢复的平均时间间隔为 10.6±4.9 小时，平均手术时间为 54.9±10.0 分钟。平均随访时间为 36.1±14.5 个月。12 个月、24 个月和 48 个月的初始通畅率分别为 75.3%、61.9%和 55.7%。24 个月和 48 个月的二次通畅率分别为 92.2%和 85.2%。Cox 多因素分析显示，单一血管流出道是初始通畅率丧失的独立危险因素。
在选择的患者中，腘动脉孤立性损伤的血管内修复可能是一种安全有效的治疗方法，中期结果可接受。单一血管流出道是初始通畅率丧失的独立危险因素。
