Abul Hasan Muhammad Bashar
Current Position
Associate Professor
National Institute of Cardiovascular Diseases & Hospital (NICVD)
Peripheral Artery Session

Topic: Popliteal trifurcation disease: A Covid-time limb salvage ordeal


Popliteal artery along with its Tibial branches constitutes the main arterial supply to the leg and foot. As arterial branching sites are particularly predisposed to atherosclerotic disease, popliteal trifurcation is frequently involved in peripheral arterial disease (PAD), particularly in elderly diabetic patients. The present study analyzes our experience with popliteal trifurcation pathologies in a limb salvage situation during the Covid-19 pandemic.

Patients and Methods:
Over a period of 2 years (July 2020 through June 2022), a total of 55 patients having Duplex and Computed Tomographic angiography (CTA) documented popliteal trifurcation disease presented with chronic limb threatening ischemia (CLTI) or acute on chronic limb ischemia (ACLI). On the top of atherosclerotic plaque, most patients had significant thrombus burden at or above/below the popliteal trifurcation often extending to Superficial femoral and Tibial arteries. Active or recent Covid-19 was documented in 32 patients. All patients were treated by surgical revascularization in the form of thrombo-endarterectomy with or without patch angioplasty, bypass with autologous long saphenous vein, or embolectomy. Fasciotomy was required in 15 patients. Strict Covid surgical protocol was followed for Covid positive patients.
There was no in-hospital mortality. Limb salvage defined as freedom from above/below knee amputation was achieved in 100% of the patients. Minor amputations like digital, ray or mid-foot amputation were need in 20%.
There seemed to be a significant increase in the number of patients presenting with ACLI during Covid-19 pandemic with many patients presenting with Popliteal trifurcation disease. Surgical revascularization, though tedious proved effective in limb salvage in this group of patients. Results in this series suggest that surgical revascularization may be the preferred mode of revascularization for Popliteal trifurcation disease presenting as CLTI/ACLI particularly in the presence of significant thrombus.