Intraoperative digital subtraction angiography (DSA) is an established imaging technique in neurosurgery that provides high resolution images of blood vessels in the central nervous system. Radial and popliteal artery access has become more prevalent but transpopliteal access is still not widely used. Performing vascular spine procedures with the patient in a prone position can be difficult due to the risk of flipping them after a sheath has been placed and the difficulty in accessing the spine area from a transradial access. Popliteal access, available through the prone position, could represent an alternative and its potential benefits are analyzed in this study.
A retrospective case series of four consecutive patients from July 2016 to August 2022 who received intraoperative spinal DSA through the popliteal artery was analyzed. Furthermore, a systematic review conducted in accordance with PRISMA guidelines was carried out to collect details of prior reported cases. This collective data on patient demographics and operative details is presented to consolidate the evidence for the use of popliteal access.
In our case series, we assessed the feasibility and safety of transpopliteal access for intraoperative Digital Subtraction Angiography (DSA) while in a prone position in four patients. Additionally, our systematic review found six published studies presenting an additional sixteen cases of transpopliteal access. In total, twenty patients were analyzed, with the majority being AVF (80%) treatments and pathology of the thoracic spine (55%) or cervical spine (25%) visualized. All outcomes were stable or saw improvement post-surgery with no reported complications.
The use of popliteal artery access for performing intraoperative digital subtraction angiography (DSA) while in a prone position appears to be a safe and feasible alternative to transfemoral or transradial access. A total of twenty patients were analyzed in our case series and systematic review with no reported complications and post-operative stabilization or improvement in all cases. The majority of the procedures involved visualizing pathology of the thoracic spine or cervical spine, while the most common procedure was AVF treatment.