Treatment of Popliteal Artery Aneurysm with Severe Limb-Threatening Acute Limb Ischemia Rutherford IIb

This protocol covers popliteal artery aneurysm (PAA) presenting with severe, limb-threatening acute limb ischemia — classified as Rutherford grade IIb. This represents an immediately threatened limb requiring urgent evaluation and management to determine viability.

In Rutherford grade IIb ischemia, prompt surgical or endovascular PAA repair is recommended. The ability to establish a viable bypass target vessel — through available operative or pharmacologic means — is a critical decision point that shapes the subsequent management pathway. Adjunctive techniques to maximise tibiopedal outflow are considered as part of the repair strategy.

When a bypass target vessel cannot be established, amputation may become necessary — with timing determined by the patient's clinical and physiologic status. The complete decision framework, including the criteria and sequencing that govern this pathway, is detailed in the full structured protocol.