PC174 Outcomes in Endovascular Therapy for Popliteal Artery Injuries After Total Knee Replacement

Popliteal artery injury is a rare but serious complication of total knee arthroplasty (TKA). Incidence of these injuries ranges from 0.03% to 0.51%. Endovascular techniques are emerging as safe and effective approaches to popliteal injury. Cases of popliteal artery injury treated with endovascular therapies have been published, although there have been no large series or prospective analysis. In this study, we reviewed the experience and reported the safety and efficacy of popliteal stenting for management of the orthopedic vascular complication. Patients undergoing TKA complicated by popliteal artery injury between December 2011 and June 2016 were identified in the medical record at a single high-volume center. All patients who underwent endovascular therapy for popliteal artery injury were included in the analysis. Data were extracted by a single reviewer. Ten patients undergoing endovascular therapy for popliteal artery injury during TKA were identified. Eight were primary procedures, and two were redo TKA procedures. Mean age was 65 years, with eight female patients and two male patients. No patient had previously documented peripheral vascular disease. In 90% of cases, the popliteal injury was a focal dissection and was recognized as acute ischemia in the postanesthesia unit. In these cases, intervention was conducted the same day. In one patient, popliteal laceration was identified 24 hours after TKA, and popliteal angiography was performed emergently. Endovascular therapy was successful in all cases, and there were no conversions to open surgery. All patients were treated with a Viabahn stent graft (W. L. Gore and Associates, Newark, Del). Intravascular ultrasound imaging was used in 70% cases to assess vessel diameter and a minimal 5% stent graft oversizing was used. Follow-up with duplex examination results were available in all patients, with a mean follow-up of 13 months (range, 1-45 months). Primary patency at follow-up was 100% in this sample. Procedural complications included retroperitoneal hematoma in one patient, who did not require intervention, one patient experienced pulmonary embolus, and chronic numbness of the lower leg occurred in one patient. No patients required secondary intervention for limb salvage. Endovascular therapy for popliteal artery injury during TKA is safe and effective, with excellent midterm patency in this sample. Procedural complications were related to the magnitude of the original orthopedic surgery in most cases. Long-term data in a large sample are needed to draw conclusions about the ultimate durability to this approach.