Endovascular treatment of an occluded popliteal aneurysm with locoregional thrombolysis followed by stent graft exclusion.

Popliteal artery aneurysms can thrombose or cause distal embolization and are therefore potentially limb-threatening lesions. This report describes the case of a 70-year-old man with severe claudication due to a thrombosed aneurysm of the left popliteal artery. He gave consent for a locoregional thrombolytical therapy, but refused standard surgical treatment. Thus, we developed the idea to restore blood flow by means of thrombolysis first, and then to perform a definitive repair of the aneurysm after a period of time. After successful thrombolysis and after 14 days as an outpatient with weight adjusted subcutaneous heparin and daily exercise, the man was free of symptoms. An endovascular repair with a Hemobahn stentgraft was performed. At the end, the procedure was successfull. This stepwise endovascular approach can change an acute into an elective situation and positively influence long-term results.