Outcomes of Popliteal Artery Injury – Our Level 1 Trauma Center Experience from Pakistan

Background: Traumatic vascular injury poses a major healthcare problem for patient management in third-world countries. Popliteal artery injuries(PAIs) are associated with the highest risk of amputation and require early recognition and diagnosis for the timely management of patients. Our study focuses on traumatic PAIs managed at a specialised vascular surgery center, assessing the success in limb salvage following such injuries, postoperative functional outcomes and residual symptoms at 3 and 6 months. Methods: A retrospective observational study was conducted at the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from January 2020 to December 2022, using the online database after IRB approval. Data from 103 patients with diagnosed PAIs were analyzed, including demographics, mode of injury, perioperative details, and outcomes. Follow-up data at 3 and 6 months assessed limb salvage, functional outcomes, and complications. Statistical analysis was performed using SPSS Version 26, a p-value of <0.05 was considered significant. Results: 93.5% of the cases were received in the ER whereas the remaining injuries were admitted via the Vascular OPD. The median(IQR) time since the presentation was 10 hours. Firearm injuries(60.2%) were the leading cause, followed by RTAS (36.1%). PAI repair with autogenous great saphenous vein graft was undertaken in 67.6% of cases while primary above-knee amputation was performed in 25.2% of cases. Wound infections emerged as the most common complication(17.5%). At 3-month follow-up, secondary amputation occurred in 3 cases. Conclusion: PAIs with delayed presentation carry a high limb loss rate. Early referral to a vascular specialist service is pertinent to improve limb salvage.