Management of distal femoral and popliteal artery injuries: a retrospective study

BACKGROUND: Lower limb arterial injury associated with musculoskeletal injury poses a challenging problem. The primary goal is the prevention of death and salvation of limbs. The aim of this study was to assess the outcome of patients treated for acute traumatic distal femoral and popliteal arterial injuries. METHODS: A retrospective observational study on 42 patients undergoing arterial reconstruction of lower limb distal femoral artery or popliteal artery injuries were studied. Mechanism of injury, associated bony components, method of arterial repair, bony fixation, limb salvation, prevention of death, requirement of fasciotomy, vascular complications, multiorgan dysfunction and length of hospitalization were documented. Descriptive statistics were expressed as frequencies and percentage. RESULTS: Road traffic accident with closed injury was common (83.33%). Closed fracture (69.05%) was most common associated bony component. Vein graft (66.67%) was commonly performed on these patients. Limb salvage rate was 85.71% with survival rate of 100%. Amputation rate was 14.29%. Limb was salvaged in 3 cases, in whom 2 cases had a MESS Score of 8 and 1 case had score of 9. Hence, limb can be salvaged even with high MESS Score. Fasciotomy rate was 59.52%. There were several complications in this study such as skin necrosis (23.81%), exposed implants (7.14%), foot drop (4.76%) and more. A case of acute renal failure was observed in a patient who underwent amputation. CONCLUSIONS: Early intervention for the procedure, adequate exposure and arterial anastomosis with bony fixation leads to better prognosis with limb salvage and prevention of death.