# Hybrid Surgical Approach for Acute Limb Ischemia: A Case Report and Management Algorithm

## TL;DR

A 67-year-old man with severe leg ischemia due to a nearly thrombosed popliteal artery aneurysm was successfully treated with a hybrid surgical approach combining open and endovascular techniques.

## Contribution

This case report introduces a practical management algorithm for ALI emphasizing hybrid revascularization and adjunctive therapies for limb salvage.

## Key findings

- Hybrid revascularization improved distal perfusion and restored motor and sensory function in a patient with acute limb ischemia.
- Isolated embolectomy was found inadequate for cases with extensive distal embolization and absent tibial run-off.
- The management algorithm highlights the importance of rapid imaging, urgent revascularization, thrombolysis, and early fasciotomy.

## Abstract

Acute limb ischemia (ALI) is a time-critical vascular emergency associated with high morbidity and amputation risk if treatment is delayed. Popliteal artery aneurysms (PAAs), though less common, represent an important and often underrecognized cause. We report a 67-year-old man who presented with sudden-onset severe leg pain, pallor, sensory loss, and motor deficit, consistent with Rutherford IIb ALI. Computed tomography angiography revealed a nearly thrombosed PAA with absent distal run-off. The patient underwent hybrid revascularization combining open thrombo-embolectomy with prosthetic interposition grafting, intra- and postoperative catheter-directed thrombolysis, and prophylactic four-compartment fasciotomies. Postoperatively, distal perfusion improved significantly, sensation fully recovered, motor function was nearly restored, and independent ambulation was achieved. This case highlights extensive distal embolization with absent tibial run-off, a condition in which isolated embolectomy is often inadequate. It illustrates the effectiveness of a hybrid surgical-endovascular strategy for limb salvage and underscores the importance of rapid imaging, urgent revascularization, adjunctive thrombolysis, and early fasciotomy. These principles are summarized in a practical management algorithm.