Trauma Vascular De La Region Poplitea: Evitar La Ligadura Y Repar La Vena Mejora Los Resultados Reporte Inicial
Napoleón Méndez, Guillermo H Echeverría, Mario A Flores, Danilo B García, René Marroquín, Carlos A Marroquin
Keywords: Lesiones, Lesiones del Sistema vascular, Lesión vascular, Protocolos
Citation Information :
Méndez N, Echeverría GH, Flores MA, García DB, Marroquín R, Marroquin CA. Trauma Vascular De La Region Poplitea: Evitar La Ligadura Y Repar La Vena Mejora Los Resultados Reporte Inicial. Panam J Trauma Crit Care Emerg Surg 2022; 11 (1):14-18.
Background: Traumatic vascular injuries of the popliteal region are associated with high morbidity, including limb amputation, especially when there are combined artery and vein injuries. There is controversy in the management of venous injury: repair vs ligation of the vessel, with literature in favor of both repair and ligation. Current evidence validates the use of any of these techniques.
Objective: To describe the results of the management of vascular trauma of the popliteal vein, in which immediate or delayed repair of the popliteal vein is performed as the first option in all cases to avoid postligation edema and subsequent amputation.
Methodology: Based on the review of the literature and due to the potential benefit of repairing the injured popliteal vein, a protocol is implemented whose guideline is immediate or delayed popliteal vein repair in all cases, and the results are described.
Results: During the year 2020 and the first 3 months of 2021, eight cases with vascular injury of the popliteal region were documented. Five cases with venous injury. One was ligated and the result was amputation, four were repaired and had successful revascularization of the limb without consequences of amputation.
Conclusion: Although ligation has been described as an option for a destructive popliteal vein injury, we believe that venous revascularization offers clear advantages, avoiding postligation edema, and arterial thrombosis due to severe edema due to lack of return. Our proposal is venous reconstruction for all cases.
Feliciano DV, Rasmussen TE. Evaluation and treatment of vascular injuries. In: qqw Browner BD, Jupiter JB, Kretteck C (Eds). Skeletal Trauma. Basic Science, Management and Reconstruction. Philadelphia: Elsevier Saunders; 2015:423–435.
Liu JL, Li JY, Jiang P, et al. Literature review of peripheral vascular trauma: is the era of intervention coming? Chin J Traumatol 2020;23(1):5–9. DOI: 10.1016/j.cjtee.2019.11.003
DuBose JJ, Savage SA, Fabian TC, et al. The american association for the surgery of trauma prospective observational vascular injury treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis, management, and outcomes. J Trauma Acute Care Surg 2015;78(2):215–222; discussion 222–223. DOI: 10.1097/TA.0000000000000520 
Teixeira PGR, DuBose J. Surgical management of vascular trauma. Surg Clin North Am 2017;97(5):1133–1155. DOI: 10.1016/j.suc.2017.05.001 
Ramdass MJ, Muddeen A, Harnarayan P, et al. Risk factors associated with amputation in civilian popliteal artery trauma. Injury 2018;49(6):1188–1192. DOI: 10.1016/j.injury.2018.04.028
Keeley J, Koopmann M, Yan H, et al. Factors associated with amputation after popliteal vascular injuries. Ann Vasc Surg 2016;33:83–87. DOI: 10.1016/j.avsg.2016.02.004 
Guice JL, Gifford SM, Hata K, et al. Analysis of limb outcomes by management of concomitant vein injury in military popliteal artery trauma. Ann Vasc Surg 2020;62:51–56. DOI: 10.1016/j.avsg.2019.05.007
Asensio JA, Dabestani PJ, Miljkovic SS, et al. Popliteal artery injuries. Less ischemic time may lead to improved outcomes. Injury 2020;51(11):2524–2531. DOI: 10.1016/j.injury.2020.07.046. 
Williams TK, Clouse WD. Current concepts in repair of extremity venous injury. J Vasc Surg Venous Lymphat Disord 2016;4(2):238–247. DOI: 10.1016/j.jvsv.2015.07.003
Dua A, Desai SS, Ali F, et al. Popliteal vein repair may not impact amputation rates in combined popliteal artery and vein injury. Vascular 2016;24(2):166-170. DOI: 10.1177/1708538115589251
Manley NR, Magnotti LJ, Fabian TC, et al. Impact of venorrhaphy and vein ligation in isolated lower-extremity venous injuries on venous thromboembolism and edema. J Trauma Acute Care Surg 2018;84(2):325-329. DOI: 10.1097/TA.0000000000001746
Ratnayake AS, Samarasinghe B, Bala M. Challenges encountered and lessons learnt from venous injuries at Sri Lankan combat theatres. JR Army Med Corps 2017;163(2):135–139. DOI: 10.1136/jramc-2016-000649 Epub 2016. PMID: 27516468.
Matsumoto S, Jung K, Smith A, et al. Outcomes comparison between ligation and repair after major lower extremity venous injury. Ann Vasc Surg 2018;54:152–160. DOI: 10.1016/j.avsg.2018.05.062
Wright CB, Hobson RW, Swan KG, et al. Extremity venous ligation: clinical and hemodynamic correlation. Am Surg 1975;41(4):203–208. PMID: 1122072.
Hobson RW 2nd, Yeager RA, Lynch TG, et al. Femoral venous trauma: techniques for surgical management and early results. Am J Surg 1983;146(2):220–224 DOI: 10.1016/0002-9610(83)90377-x. PMID: 6881445.
Cross L, Hall J, Howdieshell TR, et al. Clinical anatomy of the popliteal blood vessels. Clin Anat 2000;13(5):347–353. DOI: 10.1002/1098-2353(2000)13:5<347::AID-CA4>3.0.CO;2-9. PMID: 10982994.