Outcomes of Endovascular and Open Surgical Therapy for Popliteal Artery Injury.

OBJECTIVES: Popliteal arterial injury carries an appreciable risk of limb loss and, despite advances in stent and stent-graft technology, endovascular therapy for popliteal arterial trauma is infrequently used when compared with traditional open repair. Thus, this study aims to assess outcomes of endovascular management (EM) with open surgery (OS) as a historical reference.

METHODS: An electronic search was performed (from January 2010 until June 2023) using multiple databases. Initial records were screened against eligibility criteria. Next, the full-text manuscript of articles that passed the title and abstract assessment was reviewed for relevancy of data points. Data from articles passing the inclusion criteria was extracted and tabulated. Comparative analysis was completed by performing chi-square tests and two-sampled t-tests (Welch's).

RESULTS: The twenty-four selected studies described 864 patients (96 EM; 768 OS). In the endovascular group, patients underwent procedures primarily for blunt trauma using covered, self-expanding stents, resulting in universal technical success and patency. Patients had an average LOS 7.99 ± 7.5 days and follow-up time of 33.0 ± 7.0 months, with 21% undergoing fasciotomies, 6% undergoing amputation, and 4% having pseudoaneurysms. Patients in the open surgery group were evenly divided between blunt and penetrating trauma, chiefly undergoing vein graft interposition and exhibiting fasciotomy and amputation rates of 66% and 24%, respectively. Patients had an average LOS of 5.66 ± 4.6 days and a 96% survival rate at discharge.

CONCLUSIONS: The current evidence sheds light on the nature of treatment offered by endovascular management and open surgery treatment and suggests endovascular management is associated with several important positive outcomes. Although it is difficult to directly compare endovascular and open surgical techniques, the data with respect to open surgical management of popliteal artery trauma can still provide a powerful frame of reference for the outcomes of endovascular management to date. However, this claim is weak due to the little published data for endovascular management of popliteal trauma, publication bias accompanying the published studies, and general, selection bias. Additional prospective data is necessary to define patients who specifically benefit from endovascular repair.