Abstract
A 72-year-old man was referred to our hospital because of sudden pain at rest in the left lower limb. Three-dimensional computed tomography showed a left thrombosed popliteal artery aneurysm (PAA) 3.0 cm in diameter and a right PAA 2.5 cm in diameter, with a mural thrombus. Elective surgery was planned because the patient had minimal sensory loss (numbness), anesthesia and no complaints of muscle weakness. Embolectomy could not be performed due to an organizing thrombus in the left tibial artery, but thrombolysis was performed via a chatheter in the left femoral artery for 1 week. Simple ligation of the left PAA and superficial femoral artery-pedal arterial bypass was accomplished using an in situ great saphenous vein (GSV) graft because the pedal artery was visualized on angiography. An elective right PAA aneurysmectomy and superficial femoral-anterior tibial arterial bypass were also performed using an in situ GSV graft. In patients with acute limb ischemia categories I to IIa as defined by the Society of Vascular Surgery and International Society of Cardiovascular Surgery clinical categories, preoperative intra-arterial thrombolysis might be considered as an alternative to urgent surgery in patients with a thrombosed PAA.
