Injury to the popliteal artery tends to occur in high velocity injuries such as motor vehicle accidents, especially those occurring in the anterior-posterior axis.
Protocol:
(1) Initially reduce the knee joint.
(2) Evaluate the affected limb for distal perfusion looking for:
(2a) hard signs of vascular injury
(2b) soft signs of vascular injury
(3) If no hard signs are present, then perform an ankle-brachial artery index (ABI) and/or duplex Doppler ultrasound of the affected limb.
(4) Perform emergency revascularization surgery if either:
(4a) 1 or more hard signs are present
(4b) The ABI and/or duplex doppler ultrasound is abnormal.
Else admit the patient for observation.
where:
• An abnormal ABI is < 0.9.
Hard signs of vascular injury:
(1) pulse deficit on the affected side
(2) distal ischemia
(3) active hemorrhage
(4) expanding and pulsatile hematoma
Soft signs of vascular injury:
(1) small, stable hematoma
(2) injury to an anatomically related nerve
(3) history of hemorrhage
