The longevity of stent placement in the popliteal artery after trauma is unknown. Also, metal implants are not optimal in this location because of arterial mobility. In the May issue of Vascular Disease Management, Megan M. Hanson, DO, Nathan K. Itoga, BS, and Peter Schneider, MD,
from the Tripler Army Medical Center, Hawaii, and Kaiser Foundation Hospital, Honolulu, Hawaii, describe a case in which a 20-year-old man dislocated his knee while surfing, causing trauma to the popliteal artery. He received endovascular repair with a metal stent intended as a temporary bridge to a bypass later under better conditions, but at 18 months, the artery was patent. The authors note that only two other published reports exist of stenting after blunt trauma, and they showed similar results:
This case and two other cases of stenting for blunt trauma popliteal occlusion provide follow-up with patent stents at 6 to 18 months. Angiletta et al reported endovascular repair in a 13-year-old boy with blunt popliteal trauma. The decision was to delay open vascular reconstruction due to a small saphenous vein caliber and wait until the arteries and veins matured. The patient underwent successful placement of a self-expanding nitinol stent.
At 1 year follow-up the stent remained patent and the child had grown 10 cm with no leg length discrepancy. Zimmerman et al reported endovascular repair of the popliteal artery after knee dislocation with placement of a self-expanding stent. Follow-up at 6 months showed a patent popliteal artery.
In each of the two previously reported cases, short segment thrombotic occlusions were treated with a single stent. In this case, care was taken to cross an occlusion that extended to the trifurcation and two stents were required. In each of the previously reported cases and the present case, the initial plan was to use stent as a bridge to bypass but results were reasonable and bypass was not performed.
The authors conclude that development of endovascular approaches may lead to increased use of catheter-based treatment for traumatic popliteal artery injuries. Read more at “Stent Placement to Treat Popliteal Artery Injury After Knee Dislocation in a Surfing Accident.”