Review of Surgical Treatment of Popliteal Artery Injury: Outcomes of Open vs Endovascular Repair

Background: Popliteal artery injury (PAI) is the second most common infrainguinal arterial injury and is being increasingly treated with an endovascular approach. Objective: We examined the outcomes of surgical repair of popliteal artery injury. Methods: Patients who underwent surgery for PAI were identified from National Trauma Database (NTDB) using ICD-9 and CPT codes. Patients with severe head injury (GCS <8), age ≤16 and >65 were excluded. Demographics, injury characteristics, and outcomes of endovascular repair (ER) of PAI were compared with open repair (OR). The trend of ER of PAI over time was also evaluated. Results: Between 2002 and 2010, 1,388 patients underwent surgery for PAI. The majority of PAI was treated with OR (95%) and 5% (67/1,388) was treated with ER. Endovascular repair of PAI was more commonly performed in whites (60% vs 38%, P<.001) whereas OR was performed more commonly in blacks (37% vs 10%, P<.001). Patients who underwent ER were more likely to have associated fracture (18% vs 8%, P<.001) but had a lower number of venous injury (4% vs 8%, P<.001). Overall mortality (ER: 3% vs OR: 2%), amputation rate (13% vs 19%), wound infection rate (2% vs 3%), and hospital length of stay (15 days vs 18 days) were similar between both groups. Patients who underwent ER had significantly lower rates of fasciotomy (33% vs 61%, P<.001) when compared to OR. Also, ER had been increasingly used for repair of PAI (2008: 4%, 2009: 6%, 2010: 8%, P<.001). Conclusions: Endovascular approach has been increasingly used for repair of popliteal artery injury. Patients who underwent endovascular treatment for popliteal artery injury had comparable short-term outcomes and similar hospital length of stay to OR. Endovascular approach appears to be a safe alternative to traditional OR in selected patients. VASCULAR DISEASE MANAGEMENT 2016;13(8):E176-E182