Acute thrombosis of a popliteal aneurysm may present symptoms of intermittent claudication or limb-threatening ischemia. Following clinical evaluation and duplex arterial study, CTA of the abdominal aorta and arteries of the lower extremity should be obtained. In patients with symptoms of limb-threatening ischemia, urgent arteriography using contralateral femoral artery access is obtained, and in patients with occlusion of infrapopliteal arteries, intra-arterial thrombolysis is started. Aneurysm exclusion, and in some cases partial excision of the wall of the popliteal artery aneurysm with interposition of an autologous vein or a prosthetic graft, is performed in patients without acute occlusion of the infrapopliteal arteries. The mortality rate of 3.2% in patients presenting with acute ischemia due to a thrombosed popliteal aneurysm has been reported.