Figure 11d. (a) Angiogram obtained in a 52-year-old patient who presented with acute bilateral ischemia of the lower extremities shows abrupt occlusion of both popliteal arteries (arrows). The appearance of the arteries elsewhere was normal. Embolus, PAES, and CAD were considered as possible causes. Catheter-directed thrombolysis of the right popliteal artery was performed. (b) Follow-up angiogram shows patency of the right popliteal artery (*), anterior tibial artery (black arrow), tibioperoneal trunk (white arrow), posterior tibial artery (black arrowhead), and peroneal artery (white arrowhead). (c) Angiogram obtained more distally shows patency of the trifurcation vessels. (d) Angiogram of the left lower extremity reveals spontaneous recanalization of the left popliteal artery (*) and anterior tibial artery (arrowhead) due to the systemic effects of thrombolysis and anticoagulation therapy. Arrow indicates an embolus in the tibioperoneal trunk, which was thought to have resulted from atrial fibrillation.