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COMMENTARY
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 119

Expert comments on “Acute limb ischemia secondary to popliteal artery thrombosis following total knee arthroplasty – Limb salvage by endovascular therapy”


Division of Vascular Surgery, Indiana University, Indiana, USA

Date of Web Publication3-May-2018

Correspondence Address:
Dr. Raghunandan Motaganahalli
Division of Vascular Surgery, Indiana University, Indiana
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.231854

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How to cite this article:
Motaganahalli R. Expert comments on “Acute limb ischemia secondary to popliteal artery thrombosis following total knee arthroplasty – Limb salvage by endovascular therapy”. Indian J Vasc Endovasc Surg 2018;5:119

How to cite this URL:
Motaganahalli R. Expert comments on “Acute limb ischemia secondary to popliteal artery thrombosis following total knee arthroplasty – Limb salvage by endovascular therapy”. Indian J Vasc Endovasc Surg [serial online] 2018 [cited 2021 Dec 8];5:119. Available from: https://www.indjvascsurg.org/text.asp?2018/5/2/119/231854



Authors describe a single case report of endovascular therapy for acute limb ischemia secondary to popliteal artery thrombosis.[1] Authors should be complemented for the technical success. Injuries to popliteal artery while not uncommon will carry devastating consequences if unattended. I have a few comments to be considered by the authors.

Managing a class 2B ischemia will need a team-based approach. While one can understand the limitations of a health system, it would still be appropriate for this patient to have been cared at a higher level of care where all the resources are available for the best possible outcome for the patient. Authors make an argument for lack of resources as the reason to choose the endovascular therapy; however, if one were to consider the described angiographic findings, there is a likely possibility of an embolic event that may have occurred during the procedure. Recorded slow flow as well as enclosed angiographic images attest to the fact that there was likely distal embolization. I would also caution one regarding “Dottering the lesion” in an acute thrombotic lesion as described here, as there is a significant possibility of one having an embolic complication. I did not see any comments from the authors about the possibility of compartment syndrome as I suspect that the patient likely had this complication due to foot drop being mentioned in the manuscript. While authors have a limb salvage (with foot drop), this should not be considered as an alternative and should not be a standard of care unless resources exist to manage immediate complications resulting from endovascular therapy.



 
  References Top

1.
Raju IT. Acute limb ischemia secondary to popliteal artery thrombosis following total knee arthroplasty - Limb salvage by endovascular therapy. Indian J Vasc Endovasc Surg 2018;5:115-8.  Back to cited text no. 1
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