Department of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido, Japan.
Department of Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Ann Vasc Surg. 2024 Feb;99:305-311. doi: 10.1016/j.avsg.2023.08.033. Epub 2023 Oct 17.
Popliteal artery injury (PAI) is a challenging trauma that requires prompt and accurate treatment since the probability of lower-limb amputation increases with the ischemic time. Intravascular shunting and cross-limb vascular shunting (CLS) are used as temporary vascular shunting (TVS) methods to shorten the ischemic time for limb vascular injury. CLS involves sending blood from an artery in a healthy body part to a peripheral vessel in an injured part to immediately resume blood flow to the injured limb. For closed injuries including PAI, CLS may be performed without exploring and identifying the arterial stumps and it enables early reperfusion to the ischemic limb. We report the case series of traumatic PAI treated using CLS and verify the usefulness of CLS.
All patients with traumatic PAI treated with CLS at our institution between August 2013 and December 2021 were included. Demographic and clinical patient characteristics were extracted from the medical records. Comorbid injuries, severity of acute limb ischemia based on the Rutherford grading scale, time from injury to reperfusion by CLS, time from injury to completion of artery, and the use of fasciotomy were investigated. As outcomes, we investigated the presence or absence of lower extremity amputation during the course of treatment.
We used CLS as treatment for 5 cases with traumatic PAI. Based on the Rutherford grading scale for acute limb ischemia, there were one limb with grade 2B and 4 with grade 3. Amputation of the lower extremities was avoided except for 1 extremity in which arterial reconstruction was not achieved due to unexplained cardiac arrest during surgery.
CLS enables early reperfusion of the injured limb and is effective as a TVS method for traumatic PAI with severe ischemia or soft tissue damage.
腘动脉损伤（PAI）是一种具有挑战性的创伤，需要及时、准确的治疗，因为随着缺血时间的延长，下肢截肢的概率会增加。血管内分流和交叉肢体血管分流（CLS）被用作临时血管分流（TVS）方法，以缩短肢体血管损伤的缺血时间。CLS 涉及将血液从健康身体部位的动脉输送到受伤部位的外周血管，以立即恢复受伤肢体的血液流动。对于包括 PAI 在内的闭合性损伤，CLS 可以在不探查和识别动脉残端的情况下进行，并且可以使缺血肢体早期再灌注。我们报告了使用 CLS 治疗创伤性 PAI 的病例系列，并验证了 CLS 的有用性。
我们纳入了 2013 年 8 月至 2021 年 12 月期间在我院接受 CLS 治疗的所有创伤性 PAI 患者。从病历中提取患者的人口统计学和临床特征。调查了合并伤、根据 Rutherford 分级标准评估的急性肢体缺血严重程度、CLS 再灌注至损伤的时间、动脉完成的时间以及筋膜切开术的使用情况。作为结果，我们调查了治疗过程中是否存在下肢截肢。
我们使用 CLS 治疗了 5 例创伤性 PAI。根据急性肢体缺血的 Rutherford 分级标准，有 1 肢为 2B 级，4 肢为 3 级。除了 1 肢由于手术期间不明原因的心脏骤停导致动脉重建未成功而截肢外，避免了下肢截肢。
CLS 可使受伤肢体早期再灌注，并且是治疗严重缺血或软组织损伤的创伤性 PAI 的有效 TVS 方法。
