Acute limb ischemia after standard trauma: full endo management!

Following a motorbike accident, a 52-year-old man presented with lower limb ischemia with motor and sensory deficits, right tibial fracture and a related popliteal dissection, left hand luxation, and short popliteal occlusion with remaining blood flow in BTK vessels. Based on his CT scan, what would be your strategy?

Part I - Case presentation
  • The patient was a 52-year-old man.
  • He had no particular medical history.
  • He had a motorbike accident at 60 km/h with no cranial trauma at 00:00
  • He arrived at the hospital at 09:00 with:
    • Clinical findings: lower limb ischemia with motor and sensory deficits. 
    • Body scan results: right tibial fracture, left hand luxation.
    • Vascular lesion: appearance of popliteal dissection related to the tibial comminuted fracture; short popliteal occlusion with remaining blood flow in below-the-knee (BTK) vessels.

CT scan 

CT scan

Analyze the post-traumatic CT scan and specify the initial therapeutic approach you would select, followed by the subsequent step you would take

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Part II - Treatment

The orthopedic team decided to do external fixation and wait 15 days before orthopedic repair 

We started with endovascular attempt 

  • Anterograd superficial puncture
  • 7Fr sheath up to over-the-knee popliteal artery 

First angiography

  • Short occlusion of BTK popliteal artery
  • Penumbra® catheter thromboaspiration with multiple clots
First angiography
First angiography

Second angiography

  • Satisfying result, with recuperation of the three BTK vessels 
  • Ballooning with 5 mm Mustang™ balloon dilatation catheter (Boston Scientific): 2-minute inflation
Second angiography

We opted to stent the remaining dissected lesion using a 5.5 mm x 40 mm Supera™ peripheral stent (Abbott Vascular), following prior artery dilation with a 5 mm balloon.

Stenting the dissected lesion with a SUPERA stent

Final result

  • Immediate foot recoloration
  • Fasciotomy with muscular liberation 
  • Pedal pulse

Orthopedic repair was to be planned shortly

Final result
Final result