popliteal angiography for asymptomatic knee dislocations

[Timothy Craig Hardcastle]

Sal

Call me old fashioned, but it is considered negligent by the authorities
in South Africa to not angio the posterior knee disloc. I know the
counter literature, but your case illustrates the problem - I've seen an
occlusion on day 7 of one not angio'ed by a peripheral rural hospital.
Luckily we could save the leg.

No experience with stent-grafts in Pop vessels personally, but the
experience with long-term patency and the need for a secondary
intervention with stents for thoracic outlet penetrating injuries (see
the work of DF du Toit et. al.) shows that the asymptomatic occlusion
rates are fairly high. In the pop segment there is poor collaterals and
I would be worried about long-term problems.

I suppose the thrombolysis may work, although the question is whether
you have recruited any previously dubious muscle?

Regards,
Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban
 
Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal
 
timothyhar at ialch.co.za 
 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of sjasmd at aol.com
Sent: 30 July 2008 06:36
To: trauma-list at trauma.org
Subject: popliteal angiography for asymptomatic knee dislocations


I would have enjoyed more discussion of the pros and cons of performing
angiography for asymptomatic knee dislocations. It would seem from the
few posts that there are some who still perform angiography. We had
begun to dismiss this procedure because of an overwhelming amount of
fairly good data published in the past decade that showed that signs of
vascular injury are almost always present when angiography is positive
in detecting popliteal artery injury and that detecting injury in the
absence of signs by angiography is uncommon. 

We recently saw an obese ?patient who dislocated her knee anteriorly who
underwent angiography three days after the injury because the orthopedic
service wanted angiography prior to planning knee repair. 
Angiography showed intraluminal thrombus and intimal flaps with thrombus
on them?in the midpopliteal artery. Luminal diameter was compromised
about 80%. Distal run-off angiography showed occlusion of the entire
posterior tibial artery and embolism of the midportion of the peroneal.
The anterior tibial artery was normal. see attached

We elected to place a stent graft over?the injured segment and trap the
thrombus under it.?We introduced? a 22 mm atrium stent and applied it
exactly at the site of the injury. Anatomical appearance returned with
good flow. 

patient was discharged the next day and will undergo elective
reconstruction of the knee.

any comments?
about use of angiography for knee dislocations
about use of stent graft in popliteal artery
about use of thrombolysis for the peroneal embolism


thanks

SAL SCLAFANI