Popliteal Artery Aneurysm Thrombolysis and Subsequent Treatment

Abstract

A popliteal artery aneurysm (PAA) is generally defined as a focal dilatation of the popliteal artery greater than 50 % of the vessel’s normal diameter and/or a diameter greater than 12 mm. PAA accounts for roughly 80 % of all peripheral aneurysms with a predilection for males. Treatment decision is based on the diameter and the clinical presentation of the PAA. Current practice favors treatment of asymptomatic PAAs with a diameter greater than 20 mm and all symptomatic PAAs. Symptomatic patients may present with lower extremity ischemia ranging from claudication to acute rest pain associated with PAA thrombosis and/or distal embolization. In general, there are two treatment options in patients with symptomatic PAA: endovascular repair and surgical repair, both with or without adjunctive thrombolysis. The high incidence of limb loss associated with an untreated acutely thrombosed PAA (up to 60 %) signals the importance of emergent treatment in these patients. The following case illustrates the steps necessary to diagnose and treat a patient presenting with limb ischemia due to an acutely thrombosed PAA.