A case of popliteal artery injury associated with multiligamentous knee injury successfully managed with endovascular stenting after thrombotic occlusion following vein graft revascularization

Autologous vein grafting is a common method for revascularization in cases of traumatic limb arterial injuries. However, no clear guidelines have been established regarding the use of tourniquets following vascular reconstruction. We report a case of graft thrombosis that occurred during a planned orthopedic surgery one week after the initial revascularization. The patient was a 56-year-old man with a complex ligament injury of the left knee accompanied by a popliteal artery injury. After admission to our hospital, he underwent emergency popliteal artery reconstruction using an autologous vein graft. On postoperative day 8, the patient underwent ligament reconstruction under tourniquet control, which resulted in the thrombotic occlusion of the graft. Although repeat vein grafting was attempted intraoperatively, blood flow could not be restored. Ultimately, an endovascular stent was deployed in the popliteal artery, which successfully restored perfusion. At one-year follow-up, the stent remained patent without evidence of fracture or vascular stenosis. This case highlights the potential risk of tourniquet-induced graft thrombosis, particularly in the early postoperative period. Excessive pressure and dilation of a harvested vein may damage the intimal layer, thereby increasing thrombosis risk. In patients with recent vascular reconstruction, especially those at high-risk, the use of tourniquet should be carefully considered. When necessary, meticulous planning and prophylactic strategies are crucial to minimize the risk of graft failure.