POPLITEAL VESSEL INJURIES IN MIDDLE-AGED ADOLESCENTS

Objectives: Incidence of peripheral vascular injury in pediatrics is 0.6-1.6%. Popliteal vessel injuries are exceptionally rare with increased morbidity. The purpose of this study is to provide further insight and experiences with popliteal vessel injury (PVI) in an adult level 1 ACS-verified trauma center and overall outcomes in middle-aged adolescents.

Methods: A retrospective review (2014-2022) of all middle-aged adolescents between 14-17 years with a PVI was conducted. Demographics, mechanism, GCS score, ISS, associated injuries, hard & soft signs of vascular injury, radiographic imaging, and surgical interventions were analyzed. Length of stay (LOS), discharge status and both short/long-term complications were reviewed.

Results: 12 patients were identified with PVI for a total of 19 vessels injured (artery=10, vein=9). Median age was 16.4 +/- 0.8 years, male (83%), and all resulted from firearms. Mean GCS scale was 13, ISS 11 +/- 7 and AIS-extremity = 3. Hard signs were present in 66.7% requiring emergent OR, while the remaining completed CTA imaging prior to intervention. Surgical intervention and injury patterns are listed in Table 1. Mean ischemic time 113 +/- 112 min. Fasciotomy was completed in 8 (66%) patients, while 59% had concomitant injuries requiring surgical interventions. All patients required ICU admission, a mean LOS 6 +/- 7 days, and a total hospital LOS of 23 +/- 20 days. We observed no limb loss or deaths; however, nearly two-thirds had associated morbidity related to PVI, including complications related to compartment syndrome (8%), DVT (8%), ischemic/necrotic toes (8%). All patients were discharged home and had surgical follow-up at 30-days.

Conclusion: PVIs in middle-aged adolescents are rare; however, the observed morbidity in our cohort is comparable to the adult literature. Long-term follow-up remains challenging in this subset of trauma patients and is necessary to better understand patency rates and any additional sequelae.