Thrombectomy and balloon angioplasty for a traumatic popliteal artery injury: A stent-free approach

A 25-year-old morbidly obese female and heavy smoker sustained a traumatic right knee dislocation after falling down a stairwell. Initial radiography revealed posteromedial tibial displacement with valgus deformity with resultant vascular compromise. Despite closed reduction, sustained arterial compromise persisted, with weak pulses and cold extremity. CT angiography showed right popliteal artery filling defect, consistent with thrombosis or dissection, which was confirmed to be occluded by conventional angiography, prompting urgent thrombectomy using the Penumbra aspiration system followed by balloon angioplasty. Stent placement was deliberately avoided due to the patient's young age, morbid obesity, and the anatomical challenges of the popliteal artery's location at a highly mobile joint. MRI revealed extensive ligamentous injury including ACL, PCL, and MCL tears of various degrees. At 3-week follow-up, the limb remained viable, with preserved arterial patency. This case illustrates that stent-free endovascular management can restore perfusion in traumatic popliteal artery injury while avoiding long-term complications of stent placement, especially in young patients requiring durable vascular solutions.