Endovascular Repair of Iatrogenic Popliteal Artery Injury With Acute Limb Ischemia During Unicompartmental Knee Arthroplasty

Iatrogenic popliteal artery injury is a rare but serious complication of knee arthroplasty. A 75-year-old woman developed massive bleeding and acute limb ischemia during unicompartmental knee arthroplasty. Angiography showed severe popliteal flow impairment with thrombus and absent distal runoff. Because bleeding was controlled and guidewire crossing appeared feasible, an endovascular-first strategy was chosen. After successful crossing, intravascular ultrasound confirmed severe arterial wall disruption and an adequate distal landing zone. VIABAHN stent grafts excluded the injured segment, and tibial thrombus aspiration restored distal perfusion. The patient was discharged without gait impairment. Endovascular-first treatment may be effective in selected cases.