Autologous Internal Iliac Artery Graft in a Popliteal Artery Injury Defect in War Surgery

A 23-year-old Afghan National Policeman sustained a right popliteal artery injury secondary to a ground-based blast. Initial treatment was an application of a tourniquet, and after triage at a local civilian hospital a shunt was placed, 3 hours after the initial injury, and then was transferred to Kabul for definitive care, 24 hours after injury. Extensive trauma to both legs precluded use of greater saphenous vein as a graft. To avoid an above-the-knee amputation, a branch of the internal iliac artery was harvested for grafting. Postoperative computed tomography angiography indicated the presence of excellent flow, and he was discharged fully ambulatory on postoperative day 17. Autologous arterial grafting has only been used infrequently, and in this case represents innovation in a low-resource environment. Surgical training in Afghanistan has seen great strides at the National Hospital. If this patient were treated at any other facility, he likely would have had a high amputation. Without advising or direction of coalition surgeons, the Afghan Trauma Team independently made the decision to harvest the artery and salvage the limb, and this is one example of how coalition support has bolstered the confidence of Afghan surgeons to develop unconventional solutions to conventional problems.