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International Young Surgeons Competition

IYSC04 - Time to think: Is the posterior approach best for popliteal artery injury?

Thursday, June 5, 2025
1:45 PM – 1:50 PM CT
Location: Morial CC, Second Floor, Room 224
Objectives: Popliteal artery injuries represent a significant challenge in trauma care due to their high morbidity and potential for limb loss. Although the medial surgical approach has been the standard, it is technically complex and time-consuming. The posterior approach to the popliteal artery, although known for many years, has traditionally been employed exclusively for accessing the second segment(P2), while the medial approach has been utilized for the first segment (P1) and third segments (P3) However, our experience demonstrates that the posterior approach provides rapid and effective access to all three portions of the popliteal artery.We analyzed the management and outcomes of patients with popliteal artery injuries, focusing on our experience with the posterior surgical approach for treating blunt and penetrating trauma at a level I trauma center in Cali, Colombia.

Methods: A retrospective analysis was conducted on patients aged ≥18 years with popliteal artery injuries treated at a level I trauma center between January 2011 and October 2024. Demographic and clinical data, injury mechanisms, surgical approaches, and outcomes were analyzed. Continuous variables were analyzed using Student's t-test or non-parametric tests based on distribution, and categorical variables using chi-square or Fisher's exact test. The study adhered to the IDEAL framework (Stage 1: Idea) and PROGRESS Type 1 reporting standards.

Results: Forty-two patients were included median 20 years; 83.7% male. Trauma mechanisms were predominantly penetrating (57%), Gunshot wounds mainly due to firearm injuries (96%). Blunt trauma (43%) was primarily caused by motorcycle accidents (61%). The posterior approach was performed in 76.2%. Primary closure was more frequent with the posterior approach (84% vs. 40%, p=0.011). Infections rates were lower with the posterior approach (3.1% vs. 20%, p=0.14). Amputations were also les frequent with the posterior approach (16% vs. 40%, p=0.2. No significant differences were observed in reintervention rates (7.1%), postoperative thrombosis (7.1%), or mortality (0%). Regarding the anatomical location of the injuries, 33% occurred in the first portion of the popliteal artery (60% medial vs. 25% posterior), 52% in the second portion (40% medial vs. 56% posterior), and 14% in the third portion (0% medial vs. 19% posterior, p=0.086).

Conclusions: The posterior approach is a viable and safe alternative for managing popliteal artery trauma in all three segments. When performed by trained personnel, it is associated with shorter operative times and a low amputation rate.