Traumatic Popliteal Artery Injury: Mechanism Influences Operatives Choices

INTRODUCTION: Traumatic popliteal artery injuries (PAI) are complex and associated with the highest amputation rate of all peripheral vascular injuries. The impact of injury mechanism on outcomes after PAI has not been adequately studied at the population level. We hypothesize that blunt PAI is associated with higher amputation rates than penetrating PAI in a large national cohort. METHODS: This was a review of all trauma patients with PAI in the American College of Surgeons TQIP 2019, excluding transfers. Outcomes between blunt and penetrating PAI were compared using univariate and multivariate analyses. RESULTS: A total of 470 patients were eligible (81% male, age 35 ± 15 years, median Injury Severity Score 10 [9 to 16]), with an equal distribution of blunt vs penetrating mechanism (Table). Overall mortality was 3%. Operative interventions are shown in the Table. Blunt PAI was associated with significantly higher primary (24% vs 2%, p < 0.0001) and secondary amputation rates (67% vs 30%, p < 0.0001), and penetrating PAI had a higher rate of bypass (73% vs 61%) and primary repair (26% vs 17%) at the index operation (both p < 0.0001). Blunt PAI resulted in more repeat operations (20% vs 10%, p = 0.01) and longer ICU and hospital length of stay. Table. - Blunt vs Penetrating Popliteal Injury Outcomes Blunt, 235 (50) Penetrating, 235 (50) p Value Primary operation Bypass 144 (61) 170 (73) <0.0001 Repair 40 (17) 60 (26) <0.0001 Amputation 56 (24) 5 (2) <0.0001 Fasciotomy 101 (43) 121 (52) 0.065 Second operation 48 (20) 23 (10) 0.001 Delayed amputation 32 (67) 7 (30) <0.0001 CONCLUSION: Blunt PAI is associated with higher morbidity than penetrating PAI, including higher primary and secondary amputation rates, more operations, and longer length of stay. Further study is needed to understand the cause for amputation and to improve therapies for blunt popliteal vascular injuries.