Diagnostic pitfalls of computed tomography angiography in high-energy knee trauma: two case reports on complete popliteal artery transection despite preserved distal flow

This report describes two rare cases of complete popliteal artery transection in young, previously healthy men following high-energy trauma. In both cases, computed tomography (CT) angiography demonstrated a segmental arterial defect with preserved distal flow and no contrast extravasation, resulting in a delayed or uncertain diagnosis. These cases underscore the importance of incorporating the mechanism of injury into clinical decision-making. Both patients exhibited neurologic deficits in the affected limbs. Physical examination revealed signs of ischemia and sensorimotor dysfunction. Despite discordant CT findings, surgical exploration confirmed complete arterial transection in both cases, necessitating vascular reconstruction. In cases of high-energy knee trauma, surgical exploration should be considered when clinical findings suggest neurovascular compromise, even if CT angiography demonstrates preserved distal flow.