Management of acute limb ischemia due to thrombosed popliteal artery aneurysm

PAA: popliteal artery aneurysm; DSA: digital subtraction angiography; ALI: acute limb ischemia; AAA: abdominal aortic aneurysm.

* Patency and morphology of PAA can be determined using duplex ultrasound.

¶ Either a patient with known PAA who develops acute symptoms or patient with newly diagnosed PAA. Symptoms associated with thrombosed PAA include symptoms/signs of ALI (ie, pain, pallor, diminished or absent pulses) or distal embolization. Refer to UpToDate topics discussing the clinical features and diagnosis of ALI.

Δ Individuals with thrombosed PAA are at risk for thrombosis of any or all of the distal arteries (ie, anterior tibial, posterior tibial, peroneal arteries).

◊ The approach to repair (open, endovascular) depends on the extent of the PAA, available distal target, availability of vein conduit, and patient comorbidities. Depending on the duration of ischemia, lower extremity fasciotomy may be performed.

§ Following recovery, evaluate for AAA or other peripheral artery aneurysm, including iliac artery aneurysm, femoral artery aneurysm, and contralateral PAA.

¥ Candidates for thrombolysis include those with no visible distal target vessel or with multiple thrombi on arteriography, and without contraindications to thrombolytic therapy (eg, recent stoke, gastrointestinal bleeding).

‡ The outcome of expectant management depends on the severity of ischemia, extent of thrombosis, and potential for collateralization.

† Thrombectomy is unlikely to be successful for a tibial vessel that was occluded prior to the acute event. For patients with severe ischemia and extensive outflow vessel thrombosis, await demarcation for amputation.