Guideline sources The following summarized guidelines for the evaluation and management of popliteal artery aneurysm (PAA) are prepared by our editorial team based on guidelines from the Society for Vascular Surgery (SVS 2022), the European Society for Vascular Surgery (ESVS 2020), and the American Heart Association (AHA/ACC 2006). 1 2 3 Guidelines 1. Diagnostic investigations Diagnostic imaging: obtain ultrasound in patients with a palpable popliteal mass to exclude PAA. B Screening for other aneurysms: screen for both a contralateral PAA and an AAA in patients presenting with a PAA. B 2. Medical management Antiplatelet therapy: consider initiating antiplatelet therapy in patients with PAAs. C 3. Surgical interventions https://web.pathway.md/diseases/recsHnzLmAKrviWNi 1/3 6/29/23, 11:19 PM Popliteal artery aneurysm Pathway Indications for repair: As per SVS 2022 guidelines, perform PAA repair in patients with an asymptomatic aneurysm 20 mm in diameter to reduce the risk of thromboembolic complications and limb loss. B Show 4 more As per ACC 2006 guidelines, perform PAA repair in patients with an aneurysm 20 mm in diameter to reduce the risk of thromboembolic complications and limb loss. B 4. Specific circumstances Patients with acute limb ischemia: As per SVS 2022 guidelines, stratify interventions for thrombotic and/or embolic complications of PAA by the severity of acute limb ischemia at presentation. B Show 3 more As per ESVS 2020 guidelines, consider repairing the PAA with a saphenous vein bypass in patients with acute limb ischemia secondary to thrombosis of the PAA. C Show 5 more As per ACC 2006 guidelines, consider performing catheter-directed thrombolysis or mechanical thrombectomy (or both) in patients with acute ischemia and absent runoff, to restore distal runoff and resolve emboli. C 5. Follow-up and surveillance Follow-up: As per SVS 2022 guidelines, consider obtaining annual monitoring for changes in symptoms, pulse examination, extent of thrombus, patency of the outflow arteries, and aneurysm diameter in patients with an asymptomatic PAA not offered repair. C Show 4 more As per ACC 2006 guidelines, consider obtaining annual ultrasound monitoring in patients with asymptomatic enlargement of the popliteal arteries twice the normal diameter for age and gender. C Clinical findings Symptoms Past medical history Claudication of lower limb Femoral artery aneurysm Knee pain Leg pain Leg paresthesia Leg swelling Popliteal mass Vascular exam ABI https://web.pathway.md/diseases/recsHnzLmAKrviWNi 2/3 6/29/23, 11:19 PM Popliteal artery aneurysm Pathway References 1. Alan T Hirsch, Ziv J Haskal, Norman R Hertzer et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006 Mar 21;113 11):e463 654. Open 2. Alik Farber, Niren Angle, Efthymios Avgerinos et al. The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms. J Vasc Surg. 2022 Jan;75 1S 109S 120S. Open 3. Martin Bj rck, Jonothan J Earnshaw, Stefan Acosta et al. Editor's Choice European Society for Vascular Surgery ESVS 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg. 2020 Feb;59 2 173 218. Open https://web.pathway.md/diseases/recsHnzLmAKrviWNi 3/3