Acute thrombosis of a popliteal aneurysm frequently results in limb loss due to thromboembolic occlusion of the tibioperoneal "outflow" tract. In these patients, the best prognostic indicator of limb salvage is the patency status of the tibioperoneal vessels. When these outflow vessels are occluded at arteriography, intraarterial fibrinolytic therapy may reestablish outflow when none is present preoperatively, thereby allowing the opportunity for dependable distal reconstructive surgery and thus limb salvage.