Interventional management of infrapopliteal arterial injury

• Published in: Emergency radiology Vol. 7; no. 5; pp. 276 - 282
• Main Authors: Amin, R. J., Fisher, R. G., Whigham, C. J., Lindsey, J. I., Soltes, G. D.
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Nature B.V 26.10.2000
• Subjects: Injuries; Medical imaging
• ISSN: 1070-3004; 1438-1435
• DOI: 10.1007/PL00011841

Purpose: Recent advances in angiographic and occlusive techniques have given the interventional radiologist a significant role in the management of below-the-knee arterial trauma. We wish to present our experience involving nine patients with ten infrapopliteal arterial injuries successfully managed with interventional embolotherapy. Methods and materials: Nine male patients with a mean age of 29.4 years (range 17-63 years) presented to our interventional department for evaluation of injury to the lower extremity. Mechanisms of injury were penetrating trauma, shotgun blast, or auto-pedestrian injury. Digital subtraction or cut-film angiography of the lower extremity was performed using standard Seldinger technique via the common femoral artery approach. Injuries managed were arteriovenous fistulas (30 %), transection (40 %), and pseudoaneurysm (30 %) involving the posterior tibial (20 %) and/or peroneal (80 %) arteries. Agents used included Gelfoam, Gianturco coils, and/or vasopressin. Patients were followed until discharge and as outpatients when possible. Results: All patients were successfully managed in regard to their acute injuries. Hemostasis was achieved, and surgical exploration was avoided. There were no procedure-related complications, and limb salvage rate was 100 %. Conclusion: Our experience demonstrates that current angiographic and embolotherapy techniques enable the interventionalist to successfully treat acute infrapopliteal arterial injury.[PUBLICATION ABSTRACT]