ABSTRACT
Background: Controversy persists concerning the endovascular treatment of the post-thrombotic syndrome (PTS), particularly if femoropopliteal veins are involved. Methods: We screened consecutive patients with PTS who underwent percutaneous transluminal angioplasty (PTA) of femoropopliteal veins using posterior tibial or popliteal vein access who had at least 3-month follow-up. Our assessment included the evaluation of primary and secondary patency of the treated segments by Doppler ultrasound (DUS) and clinical outcomes measured by the change in Villalta score as well as ulcer healing. Results: Among 29 patients, 8 (27.7%) were women and the mean (SD) age was 53.3 (13.6) years. Posterior tibial vein and popliteal access were used in 26 (89.7%) and 3 patients (10.3%), respectively. 13 (44.8%) patients had prior (n = 11, 37.9%) or concomitant (n = 9, 31.0%) endovascular treatment of the iliac or common femoral veins. At a median follow-up of 395 days (Q1: 205-Q3: 756 days), primary patency of femoropopliteal veins was 79.3% (95% CI 64.6-94.1%) and secondary patency was 82.8% (95% CI, 69.0-96.5%). The percentage of patients with moderate or severe PTS according to the Villalta score decreased from baseline to last follow-up from 34.5% to 18.5% and from 31% to 14.8%, respectively (p<0.003). Overall, the mean (SD) Villalta score decreased from 11.5 (1.7) to 8.0 (1.7) (p<0.0001). Postprocedural complete ulcer healing occurred in 4 out of 5 (80%) patients. Two (6.9%) patients developed new ulcers. No major bleeding, pulmonary embolism, stroke, or death occurred. Conclusion: PTA of femoropopliteal veins via posterior tibial or popliteal vein access appears to improve the severity of PTS with acceptable patency rates.
ABSTRACT
BACKGROUND: Popliteal vessel injuries are associated with traumatic knee injury often requiring emergency revascularization. Medial and posterior approaches to the popliteal space have been proposed. This study evaluates the outcome of patients treated for traumatic popliteal vessel injuries via a posterior approach. METHODS: Consecutive patients with traumatic vascular injuries in the popliteal segments II and III undergoing surgical repair via a posterior approach between October 2008 and December 2016 were analyzed. The level of the arterial injury was preoperatively confirmed by computed tomography angiography or duplex ultrasound. Surgery was performed in prone position. Perioperative and long-term outcomes were analyzed including a survey of all patients in January 2017 assessing survival, limb salvage, and claudication. RESULTS: Ten patients (8 female; median age 66 years, range 22-88) with blunt knee trauma were identified, 8 of them after spontaneous knee dislocation. Five patients had local intimal disruption and 5 had complete transection of the popliteal artery. In 6 patients, an interposition graft (vein n = 5; xenograft n = 1) was used for revascularization. Two patients underwent direct reanastomosis and in 2 patients longitudinal arteriotomy with patch plasty was performed. All arterial reconstructions were patent at discharge. Two patients had additional transection of the popliteal vein; in one, reconstruction was performed by direct reanastomosis and in another by interposition of a vein graft. The latter had asymptomatic early postoperative occlusion of the vein graft. After a median follow-up of 56 months (range 45-99), no death, limb loss, or claudication was observed. CONCLUSIONS: After traumatic knee injury, posterior approach to the popliteal vessels is feasible and effective. It allows revascularization by direct repair or a short segment interposition graft avoiding long distance bypass. A high limb salvage rate can be achieved with excellent long-term outcomes.