Trifurcation of the popliteal artery and Tibial vessel (3) occlusion with thrombosis.

In the recent few months we have seen and treated 7 men with severe pain, symptoms of ischemia due to below knee occlusion of  the popliteal artery and tibial (3) arteries. Initially they were given antiplatelet drugs and anticoagulation with no relief of symptoms. Thrombolytic therapy was started after angiogram and guide wire confirmation of the nature of the obstruction. In five patients Inj Tinectaplase and in two patients Inj Urokinase was given. All these patients were relieved of their symptoms with recanalization of the popliteal and tibial vessels and there was improvement of the ankle pressures above the critical levels.We feel that guide wire testing (ability to pass it through the occluded tibials) is crucial and determines the out comes of thrombolytic therapy.