Part 2/Chapter 5/15-min read

Peripheral Aneurysms

Popliteal and peripheral aneurysms: natural history, indications for intervention, and surgical techniques

Edited by Tal M. Hörer MD, PhD · David T. McGreevy MD, PhD·Reviewed ·18 sections · 34 references

Background

Summary: Peripheral aneurysms of the lower extremities are uncommon, but popliteal artery aneurysms (PAA) are the most frequent true peripheral arterial aneurysm and are clinically important because their dominant complications are thrombosis and distal embolization leading to acute limb ischemia and chronic limb-threatening ischemia rather than rupture.

In contrast to 4abdominal aortic aneurysm, where rupture risk drives many intervention thresholds, the management strategy for PAA prioritizes:

  • Prevention of thromboembolism and limb loss through timely repair when indicated.
  • Assessment and optimization of inflow/outflow ("runoff") because runoff strongly influences patency and limb outcomes after either open or endovascular repair.
  • Recognition of systemic aneurysmal disease (frequent association with contralateral PAA and 4abdominal aortic aneurysm (AAA)), prompting structured screening and lifelong follow-up.

Contemporary care should integrate guideline-based thresholds for elective repair, evidence-based perioperative cardiovascular risk reduction (antiplatelet therapy and high-intensity statin therapy), and a defined duplex ultrasound surveillance pathway for both unrepaired aneurysms and post-repair reconstructions.

Etiology and Risk Factors

  • Atherosclerosis (most common).
  • Connective tissue disorders (Marfan, Ehlers-Danlos, Loeys-Dietz).
  • Trauma or iatrogenic injury.
  • Infection (mycotic aneurysm, rare).
  • Male sex, age >65, smoking, hypertension, family history of aneurysms.

Pathophysiology

  • Progressive wall weakening → dilatation.
  • Popliteal artery special risk: confined space behind knee → higher risk of thrombosis and compression.
  • Thrombosis and embolism: mural thrombus forms, may occlude lumen or embolize distally.
  • Compression: nerve (neuropathy), vein (12VTE), or artery (claudication).

Clinical Presentation

  • Asymptomatic: detected incidentally by imaging or physical exam (pulsatile mass).
  • Symptomatic:
    • Claudication, rest pain.
    • Acute limb ischemia from thrombosis or embolization; classified by 10Rutherford grade (Ch. 10).
    • Distal embolization → 'blue toe' syndrome, non-healing ulcers.
    • Rare: rupture (unlike abdominal aortic aneurysm (AAA)).
    • Compression symptoms: deep vein thrombosis (DVT) may occur from popliteal vein compression— see 12Ch. 12 for management.

Physical exam: pulsatile mass in popliteal fossa; may be bilateral.

Non-Invasive Assessment

Preferred initial test

  • Duplex ultrasound (DUS) is first-line for diagnosis and surveillance because it defines aneurysm diameter, mural thrombus, and flow characteristics, and can assess inflow/outflow noninvasively.

What to document on DUS (recommended minimum dataset)

  • Maximum aneurysm diameter (outer-to-outer wall).
  • Presence and extent of mural thrombus (qualitative and, when feasible, circumferential burden).
  • Inflow disease (SFA) and outflow/runoff (tibial vessels), including evidence of distal embolization.
  • Baseline physiologic status using ankle-brachial index (ABI)/toe-brachial index (TBI) when ischemic symptoms or distal disease are suspected (see 10Ch. 10).

Cross-sectional imaging for planning

  • computed tomography angiography (CTA) is preferred for preoperative planning when repair is contemplated, particularly to map landing zones (endovascular), define calcification/tortuosity, and characterize tibial runoff.
  • magnetic resonance angiography (MRA) is appropriate when iodinated contrast is contraindicated or to reduce radiation burden, acknowledging typical limitations in heavily calcified vessels.

Catheter angiography (DSA)

  • Digital subtraction angiography (DSA) is reserved for intra-procedural guidance or when noninvasive imaging is discordant with clinical findings; it also enables simultaneous treatment of distal emboli or tibial lesions.

Screening

Associated aneurysm screening in patients with PAA

Because PAA frequently clusters with other aneurysms, all patients diagnosed with a true PAA should undergo systematic screening for additional aneurysms using noninvasive imaging.

Recommended screening targets and modalities

  • Contralateral popliteal artery:
  • DUS is preferred to confirm bilaterality, define size, and identify thrombus.
  • Abdominal aorta (abdominal aortic aneurysm (AAA) screening):
  • Abdominal ultrasound is first-line screening.
    • computed tomography angiography (CTA) is reserved for operative planning, equivocal ultrasound, or when cross-sectional imaging is already being obtained for lower-extremity planning.
  • Femoral aneurysms (common femoral / superficial femoral):
  • Consider targeted DUS or CTA review of the femoral segment given frequent multi-level aneurysmal disease.

Clinical implication

  • Discovery of associated aneurysms alters surveillance burden and may change repair sequencing (for example, symptomatic/large AAA versus threatened limb from PAA).

Indications for repair

TreatmentPAA repair indications (guideline-based framework)
  • Symptomatic PAA (ischemia, embolization, compression)
    **Typical threshold**
    Any size
    **Clinical rationale**
    Symptom status reflects clinically relevant thromboembolic risk and/or local complications.
  • Asymptomatic PAA
    **Typical threshold**
    >=25 mm
    **Clinical rationale**
    Widely used elective threshold to reduce future thromboembolic events.
  • Asymptomatic PAA with high-risk features
    **Typical threshold**
    Consider at 20-24 mm
    **Clinical rationale**
    Higher-risk natural history with mural thrombus, poor runoff, rapid growth, or prior embolization.
  • Suspected pseudoaneurysm / infected aneurysm
    **Typical threshold**
    Individualized (often urgent)
    **Clinical rationale**
    Etiology and rupture/bleeding risk differ from true degenerative PAA; treat underlying cause and plan definitive repair.

Patient- and anatomy-specific modifiers (practical guidance)

  • Vein conduit availability strongly influences open bypass durability; in good-risk patients with usable great saphenous vein, open repair is often favored for long-term patency.
  • Endovascular suitability requires adequate proximal and distal landing zones and an understanding of knee-flexion dynamics across the popliteal segment.
  • Runoff quality (tibial vessel patency) affects both open and endovascular outcomes and should be assessed explicitly during planning.

Baseline medical therapy (applies to all PAA patients)

  • Treat as systemic atherosclerotic disease: high-intensity statin therapy and antiplatelet therapy unless contraindicated.
  • Smoking cessation counseling should be routine given adverse limb and survival outcomes in symptomatic peripheral arterial disease cohorts.

Open repair (gold standard)

Open repair (bypass with aneurysm exclusion)

Technique (common approach)

  • Proximal and distal control with ligation/exclusion of the aneurysm.
  • Bypass from superficial femoral artery (SFA) to distal popliteal (or tibial target when needed) with:
    • Autologous vein preferred (reversed or in situ great saphenous vein (GSV)).
    • Prosthetic conduit reserved for selected patients when vein is unavailable, generally with inferior durability in below-knee targets.

Approach selection (practical)

  • Medial approach facilitates longer bypasses and tibial targets when distal embolization/runoff disease is present.
  • Posterior approach may be used for selected aneurysms confined to the popliteal fossa where direct aneurysm handling is required (for example, compressive symptoms), but is less flexible for tibial targets.

Outcomes and durability

  • In elective settings with good conduit and runoff, open repair provides durable long-term patency and limb salvage, historically in the 70-90% 5-year range in surgical series.
  • Presentation matters: acute thrombosis/embolization and poor runoff are associated with worse patency and higher reintervention risk.
  • Socioeconomic status (SES) also significantly impacts outcomes following revascularization for atherosclerotic peripheral arterial disease (PAD) and aneurysm repair, with lower SES associated with increased risks of adverse events and limb loss.

Antithrombotic therapy and risk reduction

  • Long-term single antiplatelet therapy and statin therapy are generally recommended for atherosclerotic PAD risk reduction after infrainguinal bypass.
  • Consideration of intensified antithrombotic strategies should be individualized based on bleeding risk and the type of reconstruction (see 10Ch. 10).

Postoperative surveillance

  • Structured duplex surveillance improves detection of clinically significant graft stenosis and supports secondary patency.

Endovascular repair

Endovascular repair (covered stent-graft exclusion)

Covered stent-grafts can exclude a popliteal artery aneurysm (PAA) with lower early physiologic stress and shorter recovery in selected patients, but durability is sensitive to anatomy and knee-flexion biomechanics across the popliteal segment.

When to consider endovascular repair

  • Elevated operative risk or limited life expectancy.
  • No adequate autologous vein conduit.
  • Favorable anatomy:
    • Adequate proximal/distal landing zones.
    • Acceptable runoff, or a plan to address tibial disease/embolization when present.

Limitations and expected outcomes

  • Compared with vein bypass, endovascular repair often has higher reintervention rates and inferior long-term primary patency in many series and reviews, emphasizing the need for careful patient selection and surveillance.
  • Early series commonly report ~60-70% primary patency at approximately 3 years, with secondary interventions improving limb outcomes; recent cohort data on self-expandable covered stents continue to support these findings in late-term follow-up.

Antithrombotic therapy (pragmatic)

  • Antiplatelet therapy is generally used after lower-extremity endovascular interventions; dual-pathway inhibition (low-dose rivaroxaban plus aspirin) reduces major adverse limb events after revascularization in appropriate patients but must be balanced against bleeding risk.

Surveillance requirement

  • Endovascular PAA repair mandates more intensive duplex surveillance than elective open bypass because of edge stenosis, thrombosis risk, and potential deformation with knee flexion.

Hybrid approaches

  • Hybrid approaches for the aortic arch typically involve extra-anatomical debranching (e.g., carotid-carotid or carotid-subclavian bypass) to create a proximal landing zone for thoracic endovascular aortic repair (TEVAR).
  • While historically considered to have limited use, these techniques are increasingly employed for complex arch pathology, though standardized definitions of procedural success remain heterogeneous across clinical studies.
  • In the management of common carotid artery (CCA) disease, hybrid interventions—such as retrograde stenting combined with open surgical exposure or carotid endarterectomy—provide a versatile alternative to traditional open or purely endovascular techniques.

Acute limb ischemia due to PAA thrombosis

Acute limb ischemia (ALI) from thrombosed/embolizing PAA

ALI from PAA is most commonly due to thrombosis or distal embolization from mural thrombus and requires urgent limb-focused management plus definitive aneurysm exclusion to prevent recurrence.

Initial actions (do not delay)

  1. Immediate systemic anticoagulation with IV unfractionated heparin unless contraindicated.
  2. Rapid clinical staging using Rutherford ALI categories (see 10Ch. 10).
  3. Expedite imaging to guide therapy: DUS for rapid confirmation and inflow/outflow assessment, with computed tomography angiography (CTA) when procedural planning is needed.

Revascularization strategy (typical)

  • Viable or marginally threatened limb (Rutherford I-IIa):
  • Consider catheter-directed thrombolysis and/or adjunctive aspiration/mechanical thrombectomy to restore runoff, followed by definitive PAA repair (open bypass with exclusion in many cases; endovascular exclusion in selected anatomy/patients).
  • Immediately threatened limb (Rutherford IIb):
  • Proceed directly to urgent open thrombectomy and bypass (often with tibial target) and aneurysm exclusion; thrombolysis is less favored due to time sensitivity.
  • Irreversible ischemia (Rutherford III):
  • Revascularization is generally not appropriate; proceed with amputation planning and systemic stabilization (see 10Ch. 10).

Key principle

  • Reperfusion alone is insufficient: the aneurysm must be excluded/treated to reduce recurrent embolization or rethrombosis.

Follow-up

Surveillance schedulePAA surveillance protocols (unrepaired and after repair)
  • 01Unrepaired PAA <25 mm without thrombus
    **Suggested interval**
    Every 6-12 months
    **Modality**
    DUS
    **Primary goals**
    Track diameter and new thrombus.
  • 02Unrepaired PAA with thrombus, documented growth, or new symptoms
    **Suggested interval**
    Every 3-6 months
    **Modality**
    DUS +/- ankle-brachial index (ABI)/toe-brachial index (TBI)
    **Primary goals**
    Detect expansion, thromboembolic change, or evolving ischemia.
  • 03Post-open bypass/exclusion
    **Suggested interval**
    1, 6, 12 months, then annually
    **Modality**
    DUS +/- ABI/TBI
    **Primary goals**
    Identify graft/anastomotic stenosis early to preserve secondary patency.
  • 04Post-endovascular stent-graft exclusion
    **Suggested interval**
    1, 3, 6, 12 months, then every 6-12 months
    **Modality**
    DUS (consider dynamic assessment)
    **Primary goals**
    Detect edge stenosis, thrombosis, kinking/compression, and aneurysm sac perfusion.

Actionable surveillance findings (practical triggers)

  • Hemodynamically significant graft stenosis on duplex (velocity criteria and waveform change) should prompt timely evaluation for revision to maintain patency.
  • After endovascular exclusion, new symptoms, reduced ABI/TBI, or duplex evidence of edge stenosis/thrombosis warrants expedited reintervention planning.

Duration of follow-up

  • Maintain lifelong surveillance, including contralateral popliteal and abdominal aortic screening/monitoring, due to frequent multi-aneurysm association.

Tables

Table 5.1ClassificationClinical Manifestations of Popliteal Aneurysms
Asymptomatic
**Approx. frequency**
30-50%
**Typical features**
Incidental on exam/imaging; pulsatile mass
Claudication
**Approx. frequency**
20-30%
**Typical features**
Progressive ischemia from thrombosis/embolization
Acute thrombosis/ALI
**Approx. frequency**
15-30%
**Typical features**
Sudden pain, pallor, paresthesia; threatened limb
Distal embolization
**Approx. frequency**
10-15%
**Typical features**
Blue toe syndrome, digital ischemia/ulceration
Rupture
**Approx. frequency**
<5%
**Typical features**
Rare; painful swelling/hematoma
Table 5.2Open vs Endovascular PAA Repair (patient selection and expectations)
Comparison A

Open bypass + exclusion (vein preferred)

Strengths
  • Durable long-term patency and limb salvage in elective cases
Trade-offs
  • Wound morbidity
  • higher physiologic stress
Comparison B

Endovascular covered stent-graft

Strengths
  • Less invasive
  • shorter recovery
Trade-offs
  • Higher reintervention risk
  • knee-flexion deformation considerations
Table 5.3TreatmentMedical Therapy for PAA Patients (systemic risk reduction and post-revascularization)
High-intensity statin
**Typical use**
Long-term for atherosclerotic risk reduction
**Evidence anchor**
HPS and peripheral artery disease (PAD) guideline support
Antiplatelet therapy
**Typical use**
Long-term PAD risk reduction; commonly after repair
**Evidence anchor**
CAPRIE/PAD guideline
Dual-pathway inhibition (rivaroxaban 2.5 mg BID + aspirin)
**Typical use**
Selected patients after lower-extremity revascularization
**Evidence anchor**
VOYAGER PAD; balance bleeding risk
Smoking cessation
**Typical use**
All patients
**Evidence anchor**
Improves survival/amputation-free survival in symptomatic PAD cohorts

Natural history and risk stratification of asymptomatic popliteal artery aneurysms (PAA)

Asymptomatic popliteal artery aneurysms most often progress to thrombotic or embolic events rather than rupture. Risk increases with larger diameter, intraluminal thrombus burden, and poor distal runoff. Rupture is rare compared to abdominal aortic aneurysms. These factors inform thresholds for elective repair and surveillance strategies.

Explicit evidence-based thresholds for elective repair (symptomatic vs asymptomatic)

Evidence-based thresholds guide the decision for elective repair. All symptomatic popliteal artery aneurysms should be repaired regardless of size. For asymptomatic aneurysms, elective repair is generally recommended at ≥25 mm. Earlier repair should be considered for aneurysms measuring 20–24 mm when accompanied by significant intraluminal thrombus, documented distal embolization, rapid growth, or compromised distal runoff. Treatment decisions must be individualized based on patient risk profile and surgical candidacy.

Structured surveillance protocols (by aneurysm size and after repair)

Surveillance protocols should be tailored to aneurysm size, thrombus burden, and treatment modality. For unrepaired popliteal artery aneurysms measuring <20–25 mm without thrombus, duplex ultrasound surveillance is recommended every 6–12 months. The surveillance interval should be shortened if thrombus develops, growth is documented, or symptoms arise. After open bypass, duplex ultrasound is recommended at 1, 6, and 12 months, then annually thereafter. After endovascular repair, more intensive surveillance is warranted with duplex ultrasound at 1, 3, 6, and 12 months, followed by every 6–12 months long-term, with particular attention to stent-graft compression or kinking during knee flexion.

Comparative outcomes: open vs endovascular repair with patient selection

Open bypass with autologous vein conduit remains the gold standard for durability, particularly in good-risk surgical candidates with adequate vein and distal runoff. Long-term patency rates of 70–90% at 5 years have been consistently reported with vein bypass. Endovascular repair with covered stent grafts offers advantages of lower perioperative morbidity and shorter hospital length of stay, making it attractive for high-risk patients or those lacking suitable vein conduit. However, endovascular repair is associated with higher reintervention rates and inferior long-term patency compared to open bypass particularly in the challenging environment across the knee joint. Anatomic suitability requires adequate proximal and distal landing zones and careful consideration of stent-graft deformation dynamics with knee flexion. Reported primary patency at 3 years commonly ranges from 60–70% in early series, with secondary interventions improving overall limb salvage rates. In the emergency setting, a systematic review and meta-analysis comparing endovascular versus open repair of popliteal artery aneurysms (PAAs) found that open repair was associated with superior primary patency, while endovascular repair offered lower perioperative complication rates; both approaches achieved comparable limb salvage outcomes. Long-term follow-up data from dedicated PAA registries confirm that endovascular repair with self-expandable covered stents such as the Viabahn device yields acceptable patency over extended follow-up, though reintervention remains more frequent than after open bypass, underscoring the importance of lifelong surveillance after endovascular PAA repair.

Associated aneurysm screening beyond AAA (contralateral popliteal and femoral aneurysms) with modality

The high frequency of multiple aneurysms in patients with popliteal artery aneurysms mandates systematic screening. Contralateral popliteal artery imaging should be performed in all patients, with duplex ultrasound as the preferred modality. Up to 50% of patients will have bilateral popliteal aneurysms. Screening for 4abdominal aortic aneurysm is essential, as the association occurs in up to 40% of cases; abdominal ultrasound is the recommended first-line imaging modality, with computed tomography angiography reserved for operative planning or when ultrasound findings are equivocal. Assessment for concomitant femoral artery aneurysms should also be considered given the frequent clustering of peripheral aneurysms in affected individuals.

References

  1. 1.
    Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease. Circulation. 2017;135(12):e726-e779.
    PubMed-indexed article2016

    The Task Force recognizes the need for objective, independent Evidence Review Committees that include methodologists, epidemiologists, clinicians, and biostatisticians who systematically survey, abstract, and assess the evidence to address systematic review questions posed in the PICOTS format.

    PubMedOpen PDF
  2. 2.
    Dawson I, et al. Popliteal artery aneurysms: epidemiology and association with AAA. *Br J Surg*. 1997. PubMed
    PubMed-indexed article1997
    PubMedDOI
  3. 3.
    Aboyans V, Ricco JB, Bartelink M-LEL, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763-816.
    PubMed-indexed article2017

    2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries.

    PubMedOpen PDF
  4. 4.
    ESVS Guidelines on the Management of Aneurysmal Disease. *Eur J Vasc Endovasc Surg*. 2020. PubMed
    PubMed-indexed article2020

    Novel carbohydrate mimics were designed which contain two 5a-carba-d-glucose residues, one each at reducing and nonreducing end, and thus these mimics are 5a,5a'-dicarba- d- glucobioses.

    PubMed
  5. 5.
    Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 20,536 high-risk individuals. Lancet. 2002;360(9326):7-22.
    PubMed-indexed article2002

    Adding simvastatin to existing treatments safely produces substantial additional benefits for a wide range of high-risk patients, irrespective of their initial cholesterol concentrations.

    PubMed
  6. 6.
    Rutherford RB (ed.). *Rutherford’s Vascular Surgery and Endovascular Therapy.* 9th Ed. Philadelphia: Elsevier; 2018. Authoritative textbook.
    Textbook referenceTextbook2018
    Source
  7. 7.
    Wanhainen A, Verzini F, Van Herzeele I, et al. Editor's Choice – ESVS 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8–93.
    PubMed-indexed article2019

    Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.

    PubMedOpen PDF
  8. 8.
    Aboyans V, et al. Measurement and interpretation of ABI. *Circulation*. 2012;126:2890–909. PubMed. ABI standardization.
    PubMed-indexed article2012
    PubMedDOIOpen PDF
  9. 9.
    Prince MR, et al. MR angiography: principles and clinical applications. *Radiology*. 2016;281:630–48. PubMed. MRA overview.
    PubMed-indexed article2016

    99mTc-labeled PSMA inhibitor MIP-1404 is a promising SPECT tracer for detection of locally recurrent or metastatic prostate cancer.

    PubMed
  10. 10.
    White CJ. Catheter-based angiography. *Circulation*. 2006;113:1460–8. PubMed. Diagnostic gold standard.
    PubMed-indexed article2006

    Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) A Collaborative Report from the American Association for Vascular Surgery/Society for V vascular surgery,* Society for Cardiovascular Angiography and Interventions, Society forVascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines.

    PubMedOpen PDF
  11. 11.
    Armstrong EJ, Wu J, Singh GD, Dawson DL, Pevec WC, Amsterdam EA, Laird JR. Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease. J Vasc Surg. 2014;60(6):1565-1571.
    PubMed-indexed articleRegistry / cohort2014

    The hypothesis that a silver-eluting alginate topical surgical dressing would lower wound complication rates in patients undergoing open arterial procedures in the lower extremity was tested by way of an investigator initiated clinical trial.

    PubMedDOI
  12. 12.
    Chakfé N, Diener H, Lejay A, et al. European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg. 2020;59(3):339–384.
    PubMed-indexed article2020

    The first case with fingolimod-associated meningitis during Mycobacterium tuberculosis in a patient with MS is reported, keeping in mind that fingolIMod treatment may reactivate latent tuberculosis, especially in endemic regions.

    PubMed
  13. 13.
    Almasri J, et al. Surveillance of bypass grafts. *BMJ*. 2018;360:k941. PubMed. Surveillance evidence.
    PubMed-indexed article2018

    Patency rates are highest for saphenous vein bypass, whereas both patency and limb salvage are markedly inferior for prosthetic grafting to below the knee targets, particularly for severe anatomic patterns of disease treated via endovascular means.

    PubMedDOIOpen PDF
  14. 14.
    Eikelboom JW, et al. Rivaroxaban with aspirin in stable vascular disease (COMPASS). *NEJM*. 2017;377:1319–30. PubMed. Anticoagulation.
    PubMed-indexed article2017

    Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assign to aspirin alone.

    PubMedDOIOpen PDF
  15. 15.
    Galland RB, et al. Long-term results of surgical treatment of popliteal aneurysm. *Br J Surg*. 2008. PubMed
    PubMed-indexed article2008

    Results indicate that although TBS‐induced DG LTP is impaired in aged, as compared to young rats, TBS during exploration of novel environments is sufficient to rescue age‐related deficits in DG LTP.

    PubMedOpen PDF
  16. 16.
    Bonaca MP, Bauersachs RM, Anand SS, Debus ES, et al. Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med. 2020;382:1994-2004.
    PubMed-indexed article2020

    In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care, and future trials in patients withsevere illness may help to confirm or exclude the possibility of a treatment benefit.

    PubMedOpen PDF
  17. 17.
    Zil-E-Ali A. A systematic review to examine the impact of socioeconomic status on revascularization for peripheral arterial disease, carotid artery surgery, and aortic aneurysm repair outcomes in the United States. J Vasc Surg. 2024. PMID: 39486599.
    PubMed-indexed articleMeta-analysis / systematic review2024
    PubMedDOI
  18. 18.
    Cassar K, et al. Randomized trial of endovascular vs open repair for popliteal aneurysm. *Ann Surg*. 2005;241:502–8. PubMed. Popliteal aneurysm evidence.
    PubMed-indexed article2005

    Carotid ePTFE interposition graft replacement seems to be safe and durable and to have no increased perioperative risk or altered intermediate-term outcomes.

    PubMedOpen PDF
  19. 19.
    Huang Y, et al. Systematic review of endovascular vs open repair for PAA. *Eur J Vasc Endovasc Surg*. 2007. PubMed
    PubMed-indexed article2007

    Endovascular repair of popliteal artery aneurysms offers similar medium-term benefits as an open repair, however, short-term graft thrombosis and reintervention rates are significantly greater.

    PubMedOpen PDF
  20. 20.
    Tielliu IF, et al. Endovascular treatment of popliteal aneurysms. *J Vasc Surg*. 2005. PubMed
    PubMed-indexed article2005
    PubMedDOI
  21. 21.
    Troisi N et al. Late outcomes of Viabahn self-expandable covered stents for the elective treatment of popliteal artery aneurysms. Journal of Vascular Surgery. 2025. PMID: 40639746.
    PubMed-indexed articleRegistry / cohort2025
    PubMedDOI
  22. 22.
    Rossi MJ et al. A Scoping Review of Definitions of Success in Endovascular Aortic Arch Repair. Journal of Endovascular Therapy. 2024. PMID: 39148208.
    PubMed-indexed articleClinical practice guideline2024
    PubMedDOI
  23. 23.
    Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. 2022. Ch. 61, Open Surgical Technique, p. 973
    Textbook
    Textbook referenceTextbook2022

    Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed.. 2022. Ch. 61, Open Surgical Technique, p. 973

    Textbook reference
  24. 24.
    Snyder EN et al. Common Carotid Disease and Interventions. Seminars in Interventional Radiology. 2026. PMID: 41592585.
    PubMed-indexed articleMeta-analysis / systematic review2026
    PubMedDOI
  25. 25.
    Hsiao HM, et al. Mechanical thrombectomy in ALI. *J Vasc Surg*. 2019;69:1127–36. PubMed. Device outcomes.
    PubMed-indexed article2019

    BVF performed after VIV TAVR results in improved residual gradients, associated with challenges in achieving optimum THV position and expansion, and could be considered in selected clinical cases.

    PubMed
  26. 26.
    Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. 2022. Ch. 85, Lower Extremity Aneurysms, p. 1406
    Textbook
    Textbook referenceTextbook2022

    Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed.. 2022. Ch. 85, Lower Extremity Aneurysms, p. 1406

    Textbook reference
  27. 27.
    Xiao X. Comparisons of outcomes of open surgery versus endovascular intervention for thrombotic popliteal artery aneurysm with acute lower limb ischemia: a systematic review. BMC Surgery. 2022. PMID: 36401240. DOI: 10.1186/s12893-022-01843-1.
    PubMed-indexed articleMeta-analysis / systematic review2022
    PubMedDOI
  28. 28.
    Moneta GL, et al. Duplex ultrasound criteria for PAD. *J Vasc Surg*. 2010;52: 539–48. PubMed. DUS accuracy.
    PubMed-indexed article2010

    In patients with severe upper extremity ischemia not amenable to standard revascularization techniques, AVR should be considered to provide limb salvage and maximize hand function.

    PubMedOpen PDF
  29. 29.
    CAPRIE Steering Committee. Clopidogrel vs aspirin. *Lancet*. 1996. PubMed
    PubMed-indexed article1996

    The anti-aggregating activity of five rising doses of clopidogrel has been compared to that of ticlopidine in atherosclerotic patients to determine the dose which should be tested in a large scale clinical trial of secondary prevention of ischemic events in patients suffering from vascular manifestations of atherosclerosis.

    PubMed
  30. 30.
    Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. 2022. Ch. 85, Lower Extremity Aneurysms, p. 1410
    Textbook
    Textbook referenceTextbook2022

    Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed.. 2022. Ch. 85, Lower Extremity Aneurysms, p. 1410

    Textbook reference
  31. 31.
    Writing Committee Members. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease. J Am Coll Cardiol. 2024. PMID: 38752899. DOI: 10.1016/j.jacc.2024.02.013.
    PubMed-indexed articleClinical practice guideline2024
    PubMedDOI
  32. 32.
    van Leeuwen GL et al. Editor's Choice - Long Term Follow Up after Endovascular Popliteal Artery Aneurysm Repair: A Two Centre, Retrospective Cohort Study (1998-2023). Eur J Vasc Endovasc Surg. 2025. PMID: 40294783. DOI: 10.1016/j.ejvs.2025.04.041.
    PubMed-indexed articleRegistry / cohort2025
    PubMedDOI
  33. 33.
    Rebelo A et al. Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair. Vascular. 2022. PMID: 38308424. DOI: 10.1177/17085381221126318.
    PubMed-indexed articleMeta-analysis / systematic review2022
    PubMedDOI
  34. 34.
    Troisi N et al. Elective Surgical Repair of Popliteal Artery Aneurysms with Posterior Approach vs. Endovascular Exclusion: Early and Long Term Outcomes of Multicentre PARADE Study. Eur J Vasc Endovasc Surg. 2024. PMID: 39154953. DOI: 10.1016/j.ejvs.2024.08.011.
    PubMed-indexed article2024
    PubMedDOI

Educational use only

AI assists this editorial workflow. Published updates are human-reviewed before publication.

Not intended to diagnose, monitor, predict, prognose, treat, or alleviate disease.

Verify clinically relevant information against primary sources and current guidelines.

AI DisclosurePrivacyTermsCautions