Management of asymptomatic popliteal artery aneurysm

PAA: popliteal artery aneurysm; AAA: abdominal aortic aneurysm; CT: computed tomography; MR: magnetic resonance; SFA: superficial femoral artery; PAD: peripheral artery disease; IAA: iliac artery aneurysm; FAA: femoral artery aneurysm.
* PAA is typically identified on vascular ultrasound but may be seen on CT or MR performed to evaluate another condition.
¶ Local pain may be associated with PAA enlargement or rupture. Limb swelling can be related to hematoma from rupture or from venous compression or thrombosis. Ischemic symptoms can include acute (pain, pallor, diminished/absent pulses) or chronic limb ischemia (eg, claudication). Refer to other UpToDate content on diagnostic evaluation of symptomatic PAA.
Δ Other peripheral artery aneurysms include IAA, FAA, SFA, and contralateral PAA. The presence of other ipsilateral aneurysms may impact the timing and surgical treatment of PAA.
◊ Repair may be indicated for significant thrombus with evidence of continued flow within the PAA even in the absence of symptoms due to the risk for embolization.
§ Imaging surveillance typically uses duplex ultrasound, which is obtained every six months after diagnosis, then if stable, every year.
¥ The approach to repair (open, endovascular) depends on the extent of the PAA and patient comorbidities.
‡ Extensive PAA includes PAA involving the entire popliteal artery, the popliteal artery crossing the knee, or the trifurcation distally.
† Open repair of PAA can be approached posteriorly (interposition graft), or medially using saphenous vein bypass.