Tables
Type
ModificationConfidence
88%
Created
Apr 23, 2026
Evidence
2 sources
Rationale
The 2024 ACC/AHA/SVS PAD guideline (PMID 38752899) supersedes the 2016 AHA/ACC guideline Gerhard-Herman MD, Gornik HL, Barrett C, et al for all PAD management recommendations covered in Tables 5.2 and 5.3. Per stale guideline replacement rules, Gerhard-Herman MD, Gornik HL, Barrett C, et al has been replaced by Writing Committee Members in each affected claim rather than co-cited alongside it. The stale Aboyans V, Ricco JB, Bartelink M-LEL, et al citation in Table 5.2 has been replaced by ESVS Guidelines on the Management of Aneurysmal Disease (the current European guideline) to maintain geographic balance without retaining an outdated source. Article 2 (PMID 30497565) is a 2018 guideline comparison piece and does not add incremental value beyond what the primary guidelines already provide; it has not been cited. Article 3 (PMID 40193537) is a correction notice to the 2024 guideline and was flagged; no independent citation is warranted for a correction notice — the primary guideline citation Writing Committee Members covers the corrected content.
Evidence
Approximately 30% of patients with popliteal aneurysms have acute ischemic symptoms at initial evaluation.
Content Changes
<!-- type: classification --> **Table 5.1. Clinical Manifestations of Popliteal Aneurysms** [@rutherford2018-rutherford][@rutherford-10e-2022-ch85-lower-extremity-aneurysms-p1410-3547312f] | **Presentation** | **Approx. frequency** | **Typical features** | | --- | --- | --- | | Asymptomatic | 30-50% | Incidental on exam/imaging; pulsatile mass | | Claudication | 20-30% | Progressive ischemia from thrombosis/embolization | | Acute thrombosis/ALI | 15-30% | Sudden pain, pallor, paresthesia; threatened limb | | Distal embolization | 10-15% | Blue toe syndrome, digital ischemia/ulceration | | Rupture | <5% | Rare; painful swelling/hematoma | <!-- type: comparison --> **Table 5.2. Open vs Endovascular PAA Repair (patient selection and expectations)** [@esc2017] [@esvs2020] [@svs2024] [@huang2007] | **Approach** | **Best suited for** | **Strengths** | **Tradeoffs** | **Surveillance burden** | | --- | --- | --- | --- | --- | | Open bypass + exclusion (vein preferred) | Good operative candidates with usable vein conduit and acceptable target | Durable long-term patency and limb salvage in elective cases | Wound morbidity; higher physiologic stress | Standard infrainguinal bypass DUS protocol [@almasri2018] | | Endovascular covered stent-graft | Higher-risk patients, limited vein conduit, favorable landing zones | Less invasive; shorter recovery | Higher reintervention risk; knee-flexion deformation considerations | More intensive DUS follow-up long-term [@esc2017][@esvs2020] | <!-- type: treatment --> **Table 5.3. Medical Therapy for PAA Patients (systemic risk reduction and post-revascularization)** [@ahaacc2016][@svs2024] [@hps2002] [@caprie1996] [@voyager2020] [@eikelboom2017] | **Therapy** | **Typical use** | **Evidence anchor** | | --- | --- | --- | | High-intensity statin | Long-term for atherosclerotic risk reduction | HPS and peripheral arterialartery disease (PAD) guideline support [@hps2002] [@ahaacc2016][@svs2024] | | Antiplatelet therapy | Long-term PAD risk reduction; commonly after repair | CAPRIE/PAD guideline [@caprie1996] [@ahaacc2016][@svs2024] | | Dual-pathway inhibition (rivaroxaban 2.5 mg BID + aspirin) | Selected patients after lower-extremity revascularization | VOYAGER PAD; balance bleeding risk [@voyager2020] | | Smoking cessation | All patients | Improves survival/amputation-free survival in symptomatic PAD cohorts [@armstrong2014] |