Vascular injury about the knee. Improved outcome.

The records of 41 patients with 43 vascular injuries about the knee (34 popliteal artery, five tibial-peroneal trunk, one proximal anterior tibial artery, and three isolated popliteal veins) were analyzed. The etiology of the injuries were gunshot wounds (22), blunt trauma (11), shotgun wounds (4), and stab wounds (4). Associated injuries included fractures (67%), popliteal vein (54%), and nerves (32%). Arterial repairs consisted of primary repair (19), lateral repair (1), saphenous vein grafts (13), and saphenous vein patching (1). Five patients received polytetrafluoroethylene (PTFE) grafts. Fasciotomy was performed in 27 limbs. The associated venous injuries (21) and isolated venous injuries (3) were managed with ligation (14), primary repair (9), and vein patch (1). The amputation rate was 11 per cent for popliteal artery injuries (4/34). No other amputations were required. All four amputations were associated with massive limb injury (3) or diagnostic delay (1). One patient died during hemodialysis for renal failure resulting from prolonged shock and myoglobinuria. Successful management correlates best with prompt repair of both popliteal arterial and venous injuries and early fasciotomy. Vein repair (vs ligation) is associated with better long-term results.