{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:01:52Z","timestamp":1791975712419,"version":"4.4.0"},"reference-count":48,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T00:00:00Z","timestamp":1745712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Isolated popliteal artery (PA) lesions account for around 1% of lower limb revascularisations. Whatever treatment modality is chosen, the effects on the artery during knee flexion must be considered. The decision between a less invasive endovascular treatment (EVT) and traditional open interventions remains complex due to anatomical, biomechanical, and pathophysiological considerations and the varying aetiology of PA lesions. Available data remain limited, making it more challenging to decide on the most effective and durable treatment approach. Nowadays, when EVT is planned, several non-stenting techniques are available, making a \u201cleave-nothing-behind strategy\u201d possible after adequate vessel preparation. If stent implantation is required, self-expanding vasculomimetic stents are preferred due to their ability to provide flexibility and resist compression during motion. This narrative review discusses the available treatment options, challenges, and specific considerations for isolated PA disease, highlighting the need for large-scale, high-quality studies to provide more robust evidence on the optimal treatment approach.<\/jats:p>","DOI":"10.3390\/jcdd12050170","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T05:21:31Z","timestamp":1745817691000},"page":"170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Treatment Options in Isolated Atherosclerotic Popliteal Artery Disease"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6485-5062","authenticated-orcid":false,"given":"Stephanie","family":"Rassam","sequence":"first","affiliation":[{"name":"Division of Vascular and Endovascular Surgery of the Department of Heart, Vascular and Endovascular Surgery, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4428-2877","authenticated-orcid":false,"given":"Rapha\u00ebl","family":"Coscas","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, CHU Ambroise Par\u00e9, Assistance Publique H\u00f4pitaux de Paris (AP-HP), 92104 Boulogne-Billancourt, France"},{"name":"UMR 1018, Inserm-Paris11-CESP, Versailles Saint-Quentin-en-Yvelines University (Paris-Saclay University), Paul Brousse Hospital, 94807 Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s00270-018-2028-7","article-title":"Incidence and Endovascular Treatment of Isolated Atherosclerotic Popliteal Artery Disease: Outcomes from the IPAD Multicenter Study","volume":"41","author":"Spiliopoulos","year":"2018","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.avsg.2014.09.005","article-title":"Popliteal Endarterectomy for Localized Popliteal Artery Disease","volume":"29","author":"Nasr","year":"2015","journal-title":"Ann. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Huseyin, S., Guclu, O., Reyhancan, A., Yuksel, V., Gurkan, S., and Canbaz, S. (2024). An old but still valuable technique for popliteal artery stenosis: Endarterectomy via the posterior approach. Medicine, 103.","DOI":"10.1097\/MD.0000000000038693"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/00000658-196602000-00008","article-title":"Autogenous Venous Bypass Grafts and Thromboendarterectomies for Atherosclerotic Lesions of the Femoropopliteal Arteries","volume":"163","author":"Barner","year":"1966","journal-title":"Ann. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jvs.2022.07.170","article-title":"Different endovascular modalities of treatment for isolated atherosclerotic popliteal artery lesions (EMO-POP) registry","volume":"77","author":"Troisi","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.avsg.2021.07.016","article-title":"Nonatheromatous Popliteal Artery Disease","volume":"79","author":"Bai","year":"2022","journal-title":"Ann. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/S1078-5884(98)80175-5","article-title":"Cystic adventitial disease of the popliteal artery: Diagnosis and treatment","volume":"15","author":"Tsolakis","year":"1998","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00000658-197807000-00007","article-title":"Endarterectomy of the Popliteal Artery for Segmental Occlusive Disease","volume":"188","author":"Inahara","year":"1978","journal-title":"Ann. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.jvs.2024.03.454","article-title":"Outcomes of endovascular intervention for atherosclerotic lesions confined to the popliteal artery","volume":"80","author":"Bloch","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Aragon\u00e9s, P., Rodr\u00edguez-Niedenf\u00fchr, M., Quinones, S., de Blas, C.S., Konschake, M., Sanudo, J.R., and V\u00e1zquez, M.T. (2021). Popliteal artery: Anatomical study and review of the literature. Ann. Anat.-Anat. Anz., 234.","DOI":"10.1016\/j.aanat.2020.151654"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jcin.2012.09.011","article-title":"Treatment of Complex Atherosclerotic Popliteal Artery Disease With a New Self-Expanding Interwoven Nitinol Stent","volume":"6","author":"Scheinert","year":"2013","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tarasiuk, A., Tubbs, R.S., Zielinska, N., Karauda, P., Gonera, B., and Olewnik, \u0141. (2023). Variations of the popliteal artery: A review. Ann. Anat.-Anat. Anz., 249.","DOI":"10.1016\/j.aanat.2023.152100"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"210","DOI":"10.3400\/avd.oa.18-00162","article-title":"Morphologic Changes of the Femoropopliteal Arterial Segment with Knee Flexion after Endovascular Therapy","volume":"12","author":"Sato","year":"2019","journal-title":"Ann. Vasc. Dis."},{"key":"ref_14","first-page":"712","article-title":"Flexions of the Popliteal Artery: Dynamic Angiography","volume":"16","author":"Diaz","year":"2004","journal-title":"J. Invasive Cardiol."},{"key":"ref_15","first-page":"431","article-title":"Flexions of the Popliteal Artery: Technical Considerations of Femoropopliteal Stenting","volume":"10","author":"Tamashiro","year":"2011","journal-title":"J. Invasive Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1097\/01.RVI.0000167866.86201.4E","article-title":"Cryoplasty for the Treatment of Femoropopliteal Arterial Disease: Results of a Prospective, Multicenter Registry","volume":"16","author":"Laird","year":"2005","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.ejvs.2015.12.015","article-title":"Five Year Outcomes of Surgical Treatment for Popliteal Artery Entrapment Syndrome","volume":"51","author":"Lejay","year":"2016","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.avsg.2025.01.007","article-title":"Evaluation of Autologous Venous Allograft for Lower Limb in the Treatment of Critical Limb Ischemia. The REVATEC (REVAscularisation Par Greffons Veineux BioproTEC) Study","volume":"114","author":"Mercier","year":"2025","journal-title":"Ann. Vasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.avsg.2020.01.091","article-title":"Endarterectomy for Isolated Atherosclerotic Lesions of the Popliteal Artery","volume":"66","author":"Gaudin","year":"2020","journal-title":"Ann. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.avsg.2022.06.100","article-title":"Outcomes of Popliteal Endarterectomy and Infrapopliteal Angioplasty for Short Atherosclerotic Popliteal Artery Occlusion: Single-Center Case Series","volume":"88","author":"Baram","year":"2023","journal-title":"Ann. Vasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Rassam, S., and Coscas, R. (2024). Percutaneous Endovascular Reconstruction of the Common Femoral Artery and Its Bifurcation. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113169"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Patrone, L., Ysa, A., Covani, M., and Lichaa, H. (2023). Antegrade Crossing Techniques for Hard Proximal Occlusion Caps Without the Use of Dedicated Chronic Total Occlusion Devices: A Pictorial Review. J. Endovasc. Ther., 30.","DOI":"10.1177\/15266028231195538"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1161\/CIRCULATIONAHA.113.001849","article-title":"Stent Placement Versus Balloon Angioplasty for the Treatment of Obstructive Lesions of the Popliteal Artery: A Prospective, Multicenter, Randomized Trial","volume":"127","author":"Rastan","year":"2013","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Nugteren, M.J., Hazenberg, C.E.V.B., Akkersdijk, G.P., Van Den Heuvel, D.A.F., Schreve, M.A., and \u00dcnl\u00fc, \u00c7. (2023). Twelve-Month Outcomes of Intravascular Lithotripsy for Treatment of Calcified Popliteal and Infrapopliteal Lesions in Patients with Chronic Limb\u2013Threatening Ischemia. J. Endovasc. Ther., 18.","DOI":"10.1177\/15266028231205421"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/S1051-0443(07)61736-9","article-title":"Peripheral Arterial Balloon Angioplasty: Effect of Short Versus Long Balloon Inflation Times on the Morphologic Results","volume":"4","author":"Zorger","year":"2002","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.jvir.2009.10.021","article-title":"Prospective, Randomized Single-center Trial to Compare Cryoplasty versus Conventional Angioplasty in the Popliteal Artery: Midterm Results of the COLD Study","volume":"21","author":"Jahnke","year":"2010","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.carrev.2024.01.004","article-title":"Matched comparison of uncoated and paclitaxel-coated balloon angioplasty for isolated popliteal lesions excluding bail-out stenting","volume":"63","author":"Noory","year":"2024","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1177\/1526602817740133","article-title":"One-Year Outcomes Following Directional Atherectomy of Popliteal Artery Lesions: Subgroup Analysis of the Prospective, Multicenter DEFINITIVE LE Trial","volume":"25","author":"Rastan","year":"2018","journal-title":"J. Endovasc. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Donas, K.P., Psyllas, A., Pitoulias, A.G., Kazemtash, M., Dahi, F., Abu Bakr, N., and Korosoglou, G. (2023). Periprocedural Outcomes of Rotational Atherectomy-Assisted Balloon Angioplasty in Isolated Atherosclerotic Popliteal Artery Lesions: The ISO-POP Trial. J. Clin. Med., 12.","DOI":"10.3390\/jcm12082797"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/1538574409345028","article-title":"Endovascular Management of the Popliteal Artery: Comparison of Atherectomy and Angioplasty","volume":"1","author":"Semaan","year":"2010","journal-title":"Vasc. Endovascular Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1177\/1526602816683933","article-title":"Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions","volume":"24","author":"Stavroulakis","year":"2017","journal-title":"J. Endovasc. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.carrev.2013.08.005","article-title":"Endovascular treatment of acute limb ischemia and proximal deep vein thrombosis using rotational thrombectomy: A review of published literature","volume":"14","author":"Lichtenberg","year":"2013","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.ejvs.2020.01.016","article-title":"Effectiveness and Safety of Percutaneous Thrombectomy Devices: Comparison of Rotarex and Angiojet in a Physiological Circulation Model","volume":"59","author":"Rusch","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1055\/a-1952-0092","article-title":"Safety and Efficacy of Rotational Thrombectomy for Treatment of Arterial Occlusions of the Lower Extremities: A Large Single-Center Retrospective Study","volume":"195","author":"Artzner","year":"2023","journal-title":"Rofo"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.jvs.2010.03.012","article-title":"Poor outcomes with cryoplasty for lower extremity arterial occlusive disease","volume":"52","author":"Schmieder","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.jvs.2008.04.003","article-title":"CryoPlasty therapy of the superficial femoral and popliteal arteries: A reappraisal after 44 months\u2019 experience","volume":"48","author":"Samson","year":"2008","journal-title":"J. Vasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.jacbts.2024.02.002","article-title":"Efficacy and Safety of Dual Paclitaxel and Sirolimus Nanoparticle-Coated Balloon","volume":"9","author":"Kawai","year":"2024","journal-title":"JACC Basic Transl. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"454","DOI":"10.4070\/kcj.2024.0006","article-title":"Clinical Outcomes After Drug-Coated Balloon Treatment in Popliteal Artery Disease: K-POP Registry 12-Month Results","volume":"8","author":"Park","year":"2024","journal-title":"Korean Circ. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.jvir.2020.12.024","article-title":"Outcomes of Drug-Coated Balloon Angioplasty for Isolated Chronic Occlusion of the Popliteal Artery: A Retrospective Single-Institution Study","volume":"32","author":"Wu","year":"2021","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jvs.2016.05.087","article-title":"Endovascular treatment of atherosclerotic popliteal artery disease based on dynamic angiography findings","volume":"65","author":"Cui","year":"2017","journal-title":"J. Vasc. Surg."},{"key":"ref_41","unstructured":"(2025, February 25). The European Device Guide by Endovascular Today [Internet]. Available online: https:\/\/evtoday.com\/device-guide\/european."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/1526602814564386","article-title":"Stent Placement vs. Balloon Angioplasty for Popliteal Artery Treatment: Two-Year Results of a Prospective, Multicenter, Randomized Trial","volume":"22","author":"Rastan","year":"2015","journal-title":"J. Endovasc. Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s12262-020-02370-0","article-title":"Supera Stent for Management of Occlusive Popliteal Artery Disease: An Indian Experience","volume":"83","author":"Dalai","year":"2021","journal-title":"Indian J. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jvs.2008.02.029","article-title":"Fracture of self-expanding nitinol stents stressed in vitro under simulated intravascular conditions","volume":"48","author":"Nikanorov","year":"2008","journal-title":"J. Vasc. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jvs.2017.01.071","article-title":"Limb flexion-induced axial compression and bending in human femoropopliteal artery segments","volume":"67","author":"Poulson","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Chang, I.S., Chee, H.K., Park, S.W., Yun, I.J., Hwang, J.J., Lee, S.A., Kim, J.S., Chang, S.-H., and Jung, H.G. (2011). The Primary Patency and Fracture Rates of Self-Expandable Nitinol Stents Placed in the Popliteal Arteries, Especially in the P2 and P3 Segments, in Korean Patients. Korean J. Radiol., 12.","DOI":"10.3348\/kjr.2011.12.2.203"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/SLA.0000000000002747","article-title":"Stent Design Affects Femoropopliteal Artery Deformation","volume":"270","author":"MacTaggart","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/BF01795060","article-title":"Anatomo-radiological study of the popliteal artery during knee flexion","volume":"17","author":"Avisse","year":"1995","journal-title":"Surg. Radiol. Anat."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/5\/170\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:22:31Z","timestamp":1760030551000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/5\/170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,27]]},"references-count":48,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcdd12050170"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12050170","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,27]]}}}