Izawa Yuta, Sato Kazuo, Tsuchida Yoshihiko
Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, Japan.
Trauma Case Rep. 2023 Jun 5;46:100863. doi: 10.1016/j.tcr.2023.100863. eCollection 2023 Aug.
There are few reports of traumatic arterial spasm in large-sized vessels in the extremities, and many surgeons are skeptical of its existence. We report a case of traumatic popliteal artery injury (PAI), which was later diagnosed as traumatic popliteal artery spasm on intraoperative angiography. A male patient, aged 54 years, was injured when a heavy object weighing approximately 100 kg fell on his right knee. Three hours after the injury, the patient was transported to our trauma center. The dorsalis pedis and posterior tibial arteries were not palpable, and his right lower leg was cold. However, he could move his ankle and toes completely and had no numbness or paresthesia in his right lower limb. Computed tomography angiography showed an interruption of the popliteal artery at the knee joint level and an enhancement on the distal side of the injury site. We diagnosed lower limb ischemia resulting from PAI and operated for revascularization. Under general anesthesia, the popliteal artery was explored via a posterior S-shaped incision in the prone position. No arterial abnormalities were observed macroscopically, and the injured area remained unidentified. Therefore, a contrast medium was injected into the popliteal artery using a 20-gauge intravascular needle, and angiography was performed, which revealed that the popliteal artery was patent; however, there was circumferential arterial stenosis at the level of the knee joint. At this point, the right lower limb's coldness had disappeared. Arterial spasm was speculated to cause the transient popliteal occlusion and lower leg ischemia. Immediate revascularization should be attempted when PAI is suspected. If no gross vascular abnormalities are confirmed, intraoperative angiography is useful for diagnosing arterial spasm.
关于四肢大血管创伤性动脉痉挛的报道较少，许多外科医生对其存在持怀疑态度。我们报告一例创伤性腘动脉损伤（PAI）病例，该病例在术中血管造影时被诊断为创伤性腘动脉痉挛。一名54岁男性患者，被一个重约100公斤的重物砸中右膝而受伤。受伤后3小时，患者被送往我们的创伤中心。足背动脉和胫后动脉搏动未触及，右小腿冰凉。然而，他的踝关节和脚趾能够完全活动，右下肢无麻木或感觉异常。计算机断层扫描血管造影显示腘动脉在膝关节水平中断，损伤部位远端有强化。我们诊断为PAI导致的下肢缺血，并进行了血管重建手术。在全身麻醉下，患者俯卧位，通过后S形切口探查腘动脉。肉眼观察未发现动脉异常，损伤区域仍无法确定。因此，使用20号血管内针向腘动脉内注入造影剂并进行血管造影，结果显示腘动脉通畅；然而，在膝关节水平有环形动脉狭窄。此时，右下肢的冰凉已经消失。推测动脉痉挛导致了短暂的腘动脉闭塞和小腿缺血。当怀疑PAI时，应立即尝试进行血管重建。如果未确认明显的血管异常，术中血管造影有助于诊断动脉痉挛。
