The thrombosed popliteal aneurysm with distal arterial occlusion--successful therapy by interdisciplinary management

Aneurysms of the popliteal artery are rare. Their rate of incidence is reported from 0.1% up to 2.8%. Whereas surgical treatment in an asymptomatic stage bears no problems, the symptomatic stage in a high percentage of patients leads to extremity loss due to thrombosis or embolism. In these cases, amputation rates are reported from 16 to 69%. In the period 1981 - 1994 we saw 39 patients suffering from 58 popliteal aneurysms: 53.4% of these aneurysms were symptomatic. 24.1% of the popliteal aneurysms angiographically showed an occlusion of the popliteal and peripheral outflow tract with concomitant critical limb ischemia. By applying a preoperative local catheter fibrinolysis the outflow tract could be reopened in 13 ischemic extremities and a receiving segment could be recanalized for reconstruction. Following this procedure, in spite of the high number symptomatic cases we gained very good postoperative results in 70.7% of the treated extremities after a maximum follow-up time of 62 months. An aneurysm is commonly seen as a contraindication for the application of lytic therapy. But in the presence of critical extremity ischemia due to a thrombosed or embolizing popliteal aneurysm, preoperative catheter fibrinolysis can often help to save the extremity.