Frank T. Padberg, MD, Joseph J. Rubelowsky, MD, Juan J

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Presentation transcript:

Infrapopliteal arterial injury: Prompt revascularization affords optimal limb salvage Frank T. Padberg, MD, Joseph J. Rubelowsky, MD, Juan J. Hernandez-Maldonado, MD, Vincent Milazzo, MD, Kenneth G. Swan, MD, Bing C. Lee, MD, Robert W. Hobson, MD Journal of Vascular Surgery Volume 16, Issue 6, Pages 877-886 (December 1992) DOI: 10.1016/0741-5214(92)90050-I Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Occlusion of all three infrapopliteal arteries at midtibia is demonstrated. Fracture is segmented and contrast is extravasating from small vessel at wound site. This limb was deemed nonsalvageable on basis of this examination, patient's advanced age (81 years), and associated injuries consisting of subdural hematoma and fractured hip. Primary below-knee amputation was performed after this intraoperative arteriogram was obtained by percutaneous femoral arterial puncture. Journal of Vascular Surgery 1992 16, 877-886DOI: (10.1016/0741-5214(92)90050-I) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Arteriogram obtained by direct puncture of popliteal artery and temporary inflow occlusion. Fractured tibia is angulated, segmented, and comminuted. Direct exploration distal to injury identified anterior tibial artery with good runoff into foot. Popliteal—anterior tibial bypass was constructed with reversed saphenous vein. Journal of Vascular Surgery 1992 16, 877-886DOI: (10.1016/0741-5214(92)90050-I) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Two arteries were injured by this gunshot wound. Normal ankle/brachial index was consistent with non-ischemic foot. However, posterior tibial arterial injury was diagnosed by noting loss of posterior tibial Doppler signal when anterior tibial artery was compressed. Posterior tibial spasm and peroneal thrombosis is demonstrated. Journal of Vascular Surgery 1992 16, 877-886DOI: (10.1016/0741-5214(92)90050-I) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Single arterial injury, pseudoaneurysm of proximal anterior tibial artery, occurred 8 days after stab wound with localized cellulitis and palpable pedal pulses. Compartmental hypertension (70 mm Hg) mandated fasciotomy. Pedal pulses remained intact after proximal and distal ligation of anterior tibial artery. Debridement of necrotic muscle was required before closure with skin graft. Journal of Vascular Surgery 1992 16, 877-886DOI: (10.1016/0741-5214(92)90050-I) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions