This protocol addresses the management of popliteal artery aneurysm (PAA) presenting with acute limb ischemia (Rutherford grade I and IIa) in the specific context of severely obstructed tibiopedal arteries — after prior attempts to establish a viable bypass target vessel have been unsuccessful.
The patient has PAA complicated by acute limb ischemia (Rutherford grade I or IIa) with severely obstructed tibiopedal arteries. This combination presents a distinct and high-stakes management challenge: adequate distal runoff cannot be established to support bypass grafting or endovascular repair.
The preceding approach — preoperative intra-arterial thrombolysis or pharmacomechanical intervention aimed at improving tibial runoff and enabling definitive PAA repair — did not achieve its goals. Specifically, patency could not be restored in at least one tibial vessel and runoff status remained inadequate, making the transition to standard bypass or endovascular repair unfeasible.
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.
Failure to establish a bypass target vessel using either lytic or operative methods can necessitate amputation, depending on the patient's clinical condition.
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