Failed reconstruction for popliteal aneurysms is more common in patients presenting with thrombosis with or without distal embolization and in those with delayed presentation of Rutherford class III ischemia and will require primary amputation (below knee (BK) or above knee (AK)). In some patients with distal embolization to the toes, a transmetatarsal amputation can be considered if the arterial reconstruction is satisfactory.