Intra-arterial thrombolysis of thrombosed popliteal artery aneurysm. A series of six cases.
OBJECTIVE
To evaluate the role of perioperative, catheter-guided fibrinolysis in the management of thrombosed popliteal artery aneurysms.


METHODS
From 1990 to 2005, six patients suffering subacute limb ischemia, secondary to thrombosis of a popliteal artery aneurysm, benefited selective intra-arterial fibrinolysis, followed by subsequent aneurysm exclusion and bypass grafting. This represents ten percent of all popliteal aneurysms operated on in that time period and 28% of all thrombosed popliteal artery aneurysms.


RESULTS
The lytic procedure was successful in all cases, restituting patency in two (n = 3), one (n = 2) or all (n = 1) crural arteries. The venous bypass graft remained patent in all but one patient. In one patient, the graft occluded at 10 months without limb loss. This outcome compares more favorable than the result obtained with emergent surgery alone for thrombosed popliteal artery aneurysms with profound limb ischemia (eight patients, of whom one required amputation at day 5 and one lost his limb at nine months following graft thrombosis).


CONCLUSIONS
Preoperative intra-arterial lytic therapy, in the setting of subacute limb ischemia caused by thrombosis of a popliteal artery aneurysm, can be considered as safe and effective.
Van Damme
H
H
Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium. hvandamme@chu.ulg.ac.be
Trotteur
G
G
Kerzmann
A
A
Limet
R
R
D000368:Aged; D000783:Aneurysm / Q000150:complications / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000628:therapy; D007866:Leg / Q000098:blood supply; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator