Sean Keith Johnston MD, Presenter: Nothing to Disclose

Nagaramesh Chinapuvvula MBBS, Abstract Co-Author: Nothing to Disclose

Anahita Dua MD, MS, Abstract Co-Author: Nothing to Disclose

Sapan S. Desai MD, PhD, Abstract Co-Author: Nothing to Disclose

Jennifer H. Johnston MD, Abstract Co-Author: Nothing to Disclose

Shelia Coogan MD, Abstract Co-Author: Nothing to Disclose

Assesment of limb viability after injury is clasically based on clinical examination and distal vessel perfusion on CT-angiography (CTA).The purpose of this study was to correlate geniculate artery (GA) perfusion with limb salvage outcomes to determine if GA perfusion status should be part of the standard CTA report in the setting of trauma to assist in evaluating limb viability

Patients with lower extremity injury were identified retrospectively using the institutional trauma database at a level I trauma center. Patients without CTA,  missing records, or under the age of 16 were excluded. Datapoints included demographics, injury severity score (ISS), mechanism of injury, popliteal and GA flow (superior medial, superior lateral, medial, inferior medial, and inferior lateral) on CTA, and limb salvage outcome (amputation vs no amputation). Statistical analysis was completed using analysis of variance (ANOVA) for continuous variables and chi-squared for categorical variables. P <0.05 was considered statistically significant. Values are presented as mean +/- standard deviation where possible.  

From 2009-2012, 84 patients with CTA-confirmed distal extremity injury were identified.There were no significant differences between groups with regard to demographic factors, mechanism of injury, or severity of injury.Amputation rates tended to increase as the number of perfused geniculate arteries decreased.Patients with 3 patent GA's as opposed to 2 or 1 regardless of the specific arteries involved were less likely to have an amputation (P<0.05).Patients who underwent amputation and had popliteal artery occlusion had fewer intact GA's than those with successful limb salvage (2.4 vs. 2.7, P=0.36).This trend remained consistent in patients with any popliteal artery injury (2.4 vs. 2.8, P=0.23).No patients with 3 or 5 patent GA's underwent an amputation (r = -0.76).  

There appears to be a inverse relationship between number of patent geniculate arteries and lower extremity amputation after traumatic injury.Geniculate collateralization may be a key marker of limb viability.Reporting the number of perfused geniculate arteries on CTA for mangled extremities may aid in clinical decision-making.

CTA assesment of genculate artery perfusion in trauma may play a key role in assesment for surgical intervention, and should be included in the CTA report when appropriate.

Johnston, S, Chinapuvvula, N, Dua, A, Desai, S, Johnston, J, Coogan, S, The Role for Radiological Evaluation of Geniculate Flow in Trauma Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008095.html