Endovascular graft bail-out post reconstruction of popliteal artery injury. First case report

A male patient who sustained a blunt trauma to the right knee and chest resulting in posterior dislocation of the knee joint and avulsion injury to the right popliteal artery (segments II and III) had a vascular repair by interposition saphenous vein graft. Postoperatively an episode of hypotension resulted in thrombotic occlusion of the graft and acute limb ischemia. Graft and distal thrombectomy, though successful, resulted in a stenotic segment with two perforations. To shorten the operating time this was managed by Viabahn Endoprothesis stent-graft through both native popliteal artery and vein graft. Immediate regain of pedal pulses was achieved, and at 6 months follow up Viabahn endograft is still patent, foot well perfused with normal pedal pulses and patient fully active. In complicated popliteal artery injuries, with complex time consuming revascularization procedures, an endovascular graft as a back up or bail-out technique might be a valid option in some selected cases with high anesthetic risk, to shorten operating time. In this context Viabahn endoprosthesis seems to be both efficient and durable on the short term.