Background
Despite all technical innovations acute thrombosis of popliteal artery aneurysms (PAA), especially with acute progress after chronic embolization, represents a therapeutic challenge and still bears an immense risk of minor and major amputations.
Material and methods
We report on five patients with acute thrombosis of PAA with transatlantic intersociety consensus (TASC) II stages IIa-IIB ischemia and severely limited run off. Recanalization was performed with the patient under local anesthesia and wire-guided rotational thrombectomy combined with continued locoregional thrombolysis for 18–24 h.
Results
The popliteal segment could be recanalized in all patients and ischemia could be successfully treated within 44–71 min operating time. Continued thrombolysis for 18–24 h achieved reopening of at least one calf vessel without complications associated with thrombolysis. Fasciotomy was necessary in one case due to compartment syndrome. During follow-up periods ranging from 4 to 32 months, 1 stent occlusion occurred with a successful redo intervention. Conversion to open surgery was not necessary.
Conclusions
The technique described here represents an effective, fast procedure to treat ischemia with low costs and which can be performed using local anesthesia. In our experience the combination of rotational thrombectomy and stent application showed a reduced duration of thrombolysis and the associated risks as well as avoidance of further embolization. The results achieved until now and the stent characteristics support its use as a definitive and durable option; however, the approval for use with the popliteal artery does not explicitly include aneurysms and therefore necessitates a dedicated informed consent. Fasciotomy is not to be considered as associated with the individual procedure but with reperfusion and compartment syndrome in general.