Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025;18(1):24-00115.
doi: 10.3400/avd.oa.24-00115. Epub 2025 Jan 21.

The Effectiveness of Surgical Thrombectomy via Below-Knee Popliteal Artery for the Treatment of Acute Limb Ischemia

Kentaro Kasa  1 , Takao Ohki  1 , Kota Shukuzawa  1 , Soichiro Fukushima  1 , Hirotsugu Ozawa  1 , Makiko Omori  1 , Yoshihiko Chono  1 , Hiromasa Tachihara  1
Affiliations

The Effectiveness of Surgical Thrombectomy via Below-Knee Popliteal Artery for the Treatment of Acute Limb Ischemia

Kentaro Kasa et al. Ann Vasc Dis. 2025.

Abstract

Objectives: Surgical thrombectomy has been established as an effective treatment for acute limb ischemia (ALI). Nevertheless, manipulation via the common femoral artery (CFA) to retrieve thrombus in the infra-popliteal artery sometimes proves less effective. Methods: We retrospectively reviewed patients undergoing surgical thrombectomy for infra-inguinal ALI from January 2010 to December 2022. The primary endpoint was the rate of amputation. Secondary endpoints were technical and clinical success rates, incidence of distal embolism, and freedom from reintervention. Results: A total of 35 patients underwent surgical thrombectomy where the popliteal artery or below is occluded. The CFA approach was utilized in 13, and the below-knee popliteal artery (BKPA) approach in 22. There were no differences in background between groups. The reintervention rate was lower in the BKPA group (BKPA group: 0% vs. CFA group: 30.8%; P = 0.01). The BKPA group showed a significantly lower incidence of distal embolism (BKPA group: 4.5% vs. CFA group: 38.5%; P = 0.02) and freedom from reintervention (BKPA group 100% at 12 months vs. CFA group: 68.7% at 12 months; log-rank P = 0.01). Conclusions: The BKPA approach-first strategy for surgical thrombectomy in the management of ALI is feasible with better outcomes compared with the CFA approach.

Keywords: acute limb ischemia; below-knee popliteal artery; surgical revascularization; thrombectomy.

PubMed Disclaimer

Figures

None
Fig. 1 The below-knee popliteal artery approach. (A) Below-knee popliteal artery (arrow) and thrombus (arrowhead). (B) Under fluoroscopic guidance, a guidewire and balloon catheter are introduced and used to remove the thrombus via thrombectomy (arrow). (C) With the balloon inflated at the catheter insertion site, a contrast agent is administered through the catheter’s guidewire lumen to confirm residual thrombus and arterial dissection.
None
Fig. 2 Analysis of freedom from reintervention and amputation. (A) Freedom from reintervention was higher in the BKPA group than in the CFA group. (B) There was no difference in freedom from amputation between the two groups. BKPA: below-knee popliteal artery; CFA: common femoral artery
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence, risk factors, outcome, and prognosis of ischemic peripheral arterial events: implications for prevention. Circulation 2015; 132: 1805–15. - PMC - PubMed
    1. Korabathina R, Weintraub AR, Price LL, et al. Twenty-year analysis of trends in the incidence and in-hospital mortality for lower-extremity arterial thromboembolism. Circulation 2013; 128: 115–21. - PubMed
    1. Fogarty TJ, Cranley JJ, Krause RJ, et al. A method for extraction of arterial emboli and thrombi. Surg Gynecol Obstet 1963; 116: 241–4. - PubMed
    1. Björck M, Earnshaw JJ, Acosta S, et al. Editor’s choice - European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg 2020; 59: 173–218. - PubMed
    1. Hess CN, Huang Z, Patel MR, et al. Acute limb ischemia in peripheral artery disease: insights from EUCLID. Circulation 2019; 140: 556–65. - PubMed