title: Intraoperative Endovascular Stent-graft Repair of a Popliteal Artery Laceration and Occlusion during Total Knee Arthroplasty.
abstract: Injury to the popliteal vessels during total knee arthroplasty is a rare but serious complication that can cause permanent loss of function. Its incidence has been reported to be on the rise with an incidence ranging from 0.03% to 0.51%. Although rare, these complications deserve attention as they may have dire consequences, with mortality reaching 7%, amputation in up to 42%, and other morbidities such as ischemic nerve injury (foot drop). We present a case of a 78-year-old female with a pulseless limb after intraoperative injury of the popliteal artery during total knee replacement surgery who was immediately investigated with digital subtraction angiography and found to have a popliteal artery laceration with significant bleeding and a distal occlusion of the artery that was repaired endovascularly. A covered stent graft was used to simultaneously exclude the arterial laceration and to recanalize the localized popliteal occlusion. To our knowledge, this is the first report of an iatrogenic popliteal artery laceration and occlusion treated endovascularly in the intraoperative time.
authors.affiliation: Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece. Electronic address: eliaskmd@gmail.com.
authors.forename: Elias
authors.initials: E
authors.lastname: Kehagias
authors.affiliation: Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Ioannou
authors.affiliation: Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kontopodis
authors.affiliation: Orthopedics Department, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: Constatinos
authors.initials: C
authors.lastname: Balalis
authors.affiliation: Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D022125:Lacerations / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*