ACUTE POPLITEAL ARTERIAL INJURY - THE ROLE OF ANGIOSCOPY

Accurate identification of arterial injury in the emergency setting co nstitutes one of the essential prognostic factors in patients presenti ng with acute popliteal arterial injury (APAI). The modalities of angi oscopy performed intraoperatively by the vascular surgeon, including t he details of how angioscopy can contribute to therapeutic decisions i n this setting, are presented. Between June 1987 and August 1993, 26 p atients presenting with 27 APAIs (one patient had a bilateral APAI) we re treated at our institution. Eighteen (67%) lesions were due to clos ed trauma, three (11%) to shotgun pellets, three (11%) to knife wounds , two (7%) to iatrogenic wounds, and one (4%) to a bullet wound. Betwe en June 1987 and January 1992 (group I, n = 20), treatment consisted o f 15 (75%) saphenous vein bypasses and five (25%) local repairs. Pre- or intraoperative arteriograms were obtained in 14 (70%) cases. Three (15%) major amputations were required after popliteal reconstruction. Between February 1992 and August 1993 (group II, n = 7), two (29%) sap henous vein grafts and five (71%) local repairs were performed after r outine intraoperative angioscopy. Arteriograms were obtained in six (8 6%) instances. No amputations were necessary in this group. As a compl ement to arteriography, intraoperative angioscopy can determine the ex tent and number of injuries, provides direct visualization of the inti ma of the entire femoropopliteal artery, even when the latter is obscu red by thrombus, and ensures a final control of popliteal artery repai r at completion. After angioscopy, local repair was possible more ofte n (71% vs. 25%, p = 0.03) and treatment was associated with a better f unctional result (0% vs. 15% amputation rate, p = 0.04) in group II.