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Popliteal Artery Trauma

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0:00

Now in terms of popliteal artery trauma,

0:03

at our institution, we use CT angiography.

0:07

I know a lot of places have tried using MRI, uh,

0:11

or MR Angiography, and perhaps they've had some luck.

0:14

Uh, but it's so inconvenient, uh, in the trauma patients,

0:18

uh, where CT A is just so easy to do.

0:21

So, uh, honestly, we do a lot of trauma

0:24

and at our hospital we are a CTA, uh, hospital.

0:28

It's still considered the gold standard

0:30

for non-invasive assessment of arteries, uh,

0:33

particularly in the setting of, uh, of injury.

0:37

Uh, this was a terrible, uh, knee injury

0:40

with a fracture dislocation, large soft tissue, uh, wound.

0:45

And, uh, here we can see the, uh, cutoff, uh, of the, uh,

0:49

artery on the, on the CTA, on the, uh, conventional as well

0:54

as the 3D uh, images.

0:56

And it's, you know, very, very straightforward.

0:59

And we have to remember this,

1:00

that when we have severe injuries,

1:02

particularly high grade knee dislocations, that up to 30%

1:06

of patients can have some vascular trauma

1:09

associated with it.

1:11

We see a lot of knee dislocations.

1:13

In my experience, a number is lower than that, closer

1:16

to 10%, uh, is what I think it is.

1:19

But, uh, that's what's quoted, uh, in the literature.

1:22

And here's just another example of a knee dislocation, uh,

1:26

example, multi-ligament injury as was discussed,

1:29

uh, earlier today.

1:31

And this is a recent, uh, paper by Larry White from Toronto

1:36

where they looked at routine mr.

1:39

And despite some of the early articles that that suggested

1:42

that it was a good technique, they did not think

1:45

that routine MR was useful

1:47

for detecting acute neurovascular injury in these

1:50

multi-ligament traumas,

1:52

and, uh, recommended

1:53

that the patient undergo further imaging.

1:57

Uh, certainly CTA being preferred, if you like to do MRA,

2:01

uh, you can certainly give that a try,

2:03

but we haven't been very successful, uh, in these, uh,

2:06

in these, uh, patients.

2:08

We usually start with clinical assessment if they have a,

2:12

a high grade, uh, uh, knee injury.

2:15

It's, uh, a vessel injury.

2:16

It's usually fairly obvious, uh, on clinical, uh,

2:20

examination, um,

2:22

but, uh, are pretty aggressive about doing, uh, CTA.

2:25

There are orthopedic articles that will tell you that the,

2:29

uh, combination of clinical exam

2:31

and this ankle brachial index are, uh, a hundred percent,

2:36

uh, accurate.

Report

Faculty

Donald Resnick, MD

Professor Emeritus, Department of Radiology

University of California, San Diego

Mini N. Pathria, MD, FRCP(C)

Division Chief, Musculoskeletal Imaging

University of California San Diego

Eric Y. Chang, MD

Adjunct Professor, Radiology

University of California, San Diego

Brady K. Huang, MD

Clinical Professor of Radiology

UC San Diego Medical Center

Tags

Musculoskeletal (MSK)

MRI

Knee