E. Steinmetz et al., Preoperative intraarterial thrombolysis before surgical revascularization for popliteal artery aneurysm with acute ischemia, ANN VASC S, 14(4), 2000, pp. 360-364
Because a popliteal artery aneurysm (PAA) generates emboli that progressive
ly deteriorate the distal arterial network, they can constitute limb-threat
ening lesions. In 20 to 40% of cases, discovery of PAA coincides with sudde
n occlusion and resulting acute ischemia. in 40 to 60% of these patients, s
urgical revascularization fails and amputation is required. The objective o
f this prospective study was to assess the value of intraarterial thromboly
sis to restore distal runoff before surgical revascularization. Between Jan
uary 1, 1992 and December 31, 1996, we treated 15 PAA causing acute ischemi
a in 15 male patients with a mean age of 66.7 years (range, 44 to 87 years)
. Diagnosis was documented by clinical examination and ultrasound imaging.
Intraarterial thrombolysis was performed under arteriographic control throu
gh a multiperforated catheter inserted by the anterograde femoral route to
the thrombus. After an initial bolus of 100,000 U of urokinase, 600,000 to
1,600,000 U was continuously infused over a period of 6 to 18 hr. Heparin s
odium was administered throughout thrombolysis. Surgical revascularization
was performed within 1 to 4 days (mean, 2 days) after thrombolysis by exclu
sion and bypass in 14 cases and percutaneous transluminal angioplasty with
stenting in 1 case. The ensuing results showed that, if performed carefully
, intraarterial thrombolysis can safely prepare patients presenting with oc
cluded PAA with acute ischemia for surgical revascularization to restore di
stal runoff. We use this combined technique routinely in our department. Mo
rbidity is low in comparison with the risks of amputation. DOI: 10.1007/s10
0169910062.