This protocol applies to patients presenting with a popliteal artery aneurysm complicated by acute limb ischemia classified as Rutherford grade I or IIa, in whom tibiopedal outflow is severely obstructed. The combination of mild-to-moderate ischemia and compromised distal runoff poses a specific technical challenge before definitive repair can be undertaken.
Management in this setting involves a preoperative interventional step aimed at improving distal runoff before definitive repair. A catheter-based or mechanical intervention is used to address tibial occlusion, followed by prompt transition to definitive popliteal artery aneurysm repair — open or endovascular.
The full structured protocol specifies the recommended intervention sequence, procedural criteria, and decision thresholds — available via the link below.
Restoration of patency in at least one tibial vessel and improved runoff status, enabling safe and effective definitive repair.
DOI: 10.1016/j.jvs.2021.04.040
We recommend that patients with mild to moderate ALI (Rutherford grade I and IIa) and severely obstructed tibiopedal arteries undergo thrombolysis or pharmacomechanical intervention to improve runoff status, with prompt transition to definitive PAA repair.
If the clot extends into the tibial arteries, without a visible runoff vessel, thrombolysis can be very useful to restore patency in at least one tibial vessel if the patient tolerates this intervention and ischemia is not worsened.
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