Success of thrombolysis as a predictor of outcome in acute thrombosis of popliteal aneurysms

J Vasc Surg. 2002 Mar;35(3):487-93. doi: 10.1067/mva.2002.119228.


Purpose: Acute limb ischemia after thrombosis of a popliteal aneurysm is a distinct and limb-threatening entity. Preoperative intra-arterial thrombolysis may improve the outcome in this challenging situation. This study retrospectively analyzed a consecutive series of patients treated with preoperative thrombolysis and subsequent revascularization.

Methods: Thirteen patients with acute limb ischemia caused by thrombosis of a popliteal aneurysm underwent catheter-directed intra-arterial thrombolysis with urokinase and subsequent vascular reconstruction. The angiographic and clinical outcome was analyzed and compared with that in the literature.

Results: Complete aneurysm thrombosis with absence of runoff was documented in 12 cases. Thrombolysis restored perfusion with patency of the popliteal artery and a one- or two-vessel runoff in 77% of cases (10/13). Early cumulative graft patency and limb salvage rates were 68% and 83%, respectively, with an ankle/brachial index of 0.8 +/- 0.2. Lytic failure followed by attempts at bypass grafting was present in three patients (23%) and resulted in above-knee amputation. Severe rhabdomyolysis and fatal pulmonary embolism were responsible for a 15% early mortality rate.

Conclusion: Preoperative thrombolysis followed by bypass grafting is a valid treatment option for patients who can withstand an additional period of ischemia that does not require immediate revascularization and intraoperative lysis. Lytic failure identifies patients with a highly compromised runoff who are probably best treated by means of subsequent amputation, without any attempts at bypass grafting.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Aneurysm / complications*
  • Aneurysm / drug therapy*
  • Extremities / blood supply*
  • Extremities / diagnostic imaging
  • Extremities / pathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Popliteal Artery* / diagnostic imaging
  • Popliteal Artery* / pathology
  • Predictive Value of Tests
  • Radiography
  • Reoperation
  • Retrospective Studies
  • Switzerland / epidemiology
  • Thrombolytic Therapy* / adverse effects
  • Thrombosis / complications*
  • Thrombosis / drug therapy*
  • Time Factors
  • Treatment Outcome
  • Urokinase-Type Plasminogen Activator / therapeutic use*
  • Vascular Patency / drug effects


  • Urokinase-Type Plasminogen Activator