Preoperative intraarterial thrombolysis before surgical revascularization for popliteal artery aneurysm with acute ischemia

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.