Humana Commercial Clinical Policy

Humana Peripheral Artery Revascularization of the Lower Extremities Form


Effective Date

02/02/2023

Last Reviewed

NA

Original Document

  Reference



Description

Peripheral artery disease (PAD) is a chronic circulation disorder in which the arteries that supply blood to the extremities (arms, legs) are abnormally narrow and cannot keep up with demand. This usually occurs in the lower extremities.

Atherosclerosis, the accumulation of fatty deposits called plaques, is often a cause of PAD. The arteries that may be involved in PAD include the aortoiliac (common iliac, external iliac), infrainguinal (femoral, popliteal or infrapopliteal [tibial, peroneal or pedal]). Affected arteries may become limited in their ability to supply blood to tissues from plaque buildup or completely blocked due to the plaques rupturing or forming clots.

Peripheral Artery Revascularization of the Lower Extremities

Effective Date: 02/02/2023
Revision Date: 02/02/2023
Review Date: 02/02/2023
Policy Number: HUM-0583-006

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

More advanced PAD symptoms in the lower extremities indicating a significant or complete artery blockage include the following:

  • Claudication, also known as intermittent claudication, is characterized by fatigue, discomfort, cramping or pain of vascular origin in the muscles of the lower extremities that is consistently caused by exercise and consistently relieved by rest (within 10 minutes).
  • Critical/chronic limb ischemia (CLI) characterized by chronic (greater than two weeks) ischemic rest pain, nonhealing wound/ulcers or gangrene in one or both legs attributable to objectively proven arterial occlusive disease by ankle-brachial index (ABI), toe-brachial index (TBI), transcutaneous oximetry or oxygen tension measurement (TcPO2) or skin perfusion pressure testing.

The management of individuals with lower extremity PAD is aimed at relieving symptoms and lowering the risk of cardiovascular disease progression and complications. Medical management involves cardiovascular risk factor reduction, lifestyle modification and other pharmacologic therapies.

For more information regarding angiography, screening and exercise rehabilitation for PAD of the lower extremities, please refer to Peripheral Artery Disease of the Lower Extremities Angiography, Screening and Exercise Rehabilitation Medical Coverage Policy.

For those with significant or disabling symptoms of claudication unresponsive to lifestyle adjustment and pharmacologic therapy, intervention (percutaneous, surgical) may be reasonable. For individuals with CLI, revascularization is a priority to establish arterial blood flow.

Endovascular revascularization interventions

are surgical procedures in which a catheter containing medications or miniature instruments are inserted through the skin or under direct visualization after open exposure of the artery for the treatment of vascular disease. Most endovascular procedures are performed percutaneously but can be performed via open access if needed. Endovascular treatment options include the following:

Peripheral Artery Revascularization of the Lower Extremities

Effective Date: 02/02/2023
Revision Date: 02/02/2023
Review Date: 02/02/2023
Policy Number: HUM-0583-006

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • Angioplasty involves a catheter with a tiny balloon at the tip is inserted into an artery that has been narrowed by the accumulation of fatty deposits and the balloon is inflated to clear and widen the arterial opening.
  • Atherectomy involves surgical removal of atherosclerotic plaque from an artery using a catheter fitted with a cutting device.
  • Stents (mesh or metal) are used to support a cleared vessel and maintain patency.

Peripheral aneurysms located within the popliteal arteries may be asymptomatic or present with ischemic symptoms such as claudication. Repair of popliteal aneurysms may be endovascular stent-grafting or open surgical bypass. During the bypass procedure, blood flow is redirected around the aneurysm with the help of a vein or synthetic graft. The aneurysm is then removed or tied off to prevent blood from refilling the aneurysm.

Surgical bypass procedures for PAD are not discussed in the context of this policy.

The PQ Bypass DETOUR System is a fully percutaneous femoral-popliteal bypass system that uses fluoroscopic guidance to move a covered stent graft from the popliteal artery into the femoral vein and from the femoral vein into the superficial femoral artery in an overlapping manner using two independent interconnections or anastomoses. The system purportedly treats large lesions (greater than 15 centimeters) by creating a large lumen stent bypass that allows unobstructed blood flow from the superficial femoral artery to the popliteal artery. (Refer to Coverage Limitations section)

Another surgical technique aimed at providing an option for an individual with chronic limb-threatening ischemia who have limited options, except amputation, is an endovascular venous arterialization of the tibial or peroneal vein with transcatheter placement of intravascular stent graft(s). Catheters are inserted under ultrasound guidance into the tibial vein at the level of the ankle and into the femoral artery at the level of the groin. Both catheters are advanced simultaneously toward each other and ultrasound waves are emitted by the arterial catheter toward the receiving venous catheter to assist the physician in determining the most optimal location for channel creation from the artery to the vein. A device consisting of a small basket with minute incision hooks is introduced to cut through valves near the bottom of the foot to maximize the arterial flow to the vein into the foot. The severed valves are rendered incompetent, allowing oxygenated blood to flow forward and into the foot. Several self-expanding covered metal stents are then placed to act as permanent conduits for blood flow to the foot. (Refer to Coverage Limitations section)

Intravascular lithotripsy (IVL) combines ultrasound mechanical pulse waves with angioplasty to purportedly treat calcified plaque in stenotic or occluded peripheral arteries. The system consists of a single-use proprietary balloon catheter, a reusable generator, and a reusable connector cable. The balloon catheter has integrated lithotripsy emitters designed to enhance angioplasty by disrupting calcified lesions before balloon revascularization. IVL has also been proposed to treat calcified lesions during transcatheter aortic valve implantation. The Shockwave peripheral intravascular lithotripsy system is an example of such a device.

Peripheral Artery Revascularization of the Lower Extremities
Effective Date: 02/02/2023
Revision Date: 02/02/2023
Review Date: 02/02/2023
Policy Number: HUM-0583-006
Page: 4 of 14

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

(Refer to Coverage Limitations section)For information regarding coronary artery intravascular lithotripsy, please refer to Code Compendium (Cardiovascular) Medical Coverage Policy.

Coverage Determination

Humana members may be eligible under the Plan for an endovascular revascularization procedure for aortoiliac disease only, when the following criteria are met:

  • Lifestyle limiting claudication (impairment of activities of daily living and work); AND
  • Inadequate response to three consecutive months of conservative therapy within the past 12 months with ALL of the following:
    • Individual has undergone supervised exercise therapy (for information regarding coverage determination/limitations, please refer to Peripheral Artery Disease of the Lower Extremities Angiography, Screening and Exercise Rehabilitation Medical Coverage Policy; AND
    • Pharmacological therapy (eg, antiplatelet medication, cilostazol) if medically appropriate and not contraindicated; AND
    • Verified smoking cessation counseling; AND
  • Positive exercise ABIAND
  • Absence of other conditions that limit ability to ambulate/exercise (eg, angina, chronic obstructive pulmonary disease, heart failure, orthopedic limitations); AND
  • Noninvasive imaging (computed tomography [CTA], duplex ultrasound or magnetic resonance angiography [MRA]) confirmation of anatomic location and stenosis severity of 70% or greater

Humana members may be eligible under the Plan for an endovascular procedure for chronic/critical limb ischemia (CLI) when the following criteria are met:

  • Noninvasive imaging (CTA, duplex ultrasound or MRA) confirmation of anatomic location and stenosis severity of 70% or greater;AND one of the following:
    • Ankle-brachial index of 0.40 or less; OR
    • Toe pressure less than 30mmHG (TBI testing);AND one of the following:
    • Gangrene; OR
    • Ischemic rest pain; OR
    • Nonhealing wound or ulcer from ischemia

Humana members may be eligible under the plan for repair of popliteal aneurysm by stent graft or open bypass when any of the following criteria are met:

Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  • Aneurysm thrombosis; OR
  • Embolic event due to aneurysm in popliteal artery; OR
  • Ultrasound imaging demonstrating a femoral or popliteal aneurysm measuring 2 cm or greater

A single stent placed across an adjacent vascular segment (eg, extending from the external iliac artery into the femoral artery) will be reimbursed as one stent.

Coverage Limitations

Humana members may NOT be eligible under the Plan for peripheral revascularization of the lower extremities for any indications other than those listed above including, but may not be limited to, the following:

  • Claudication due to infrainguinal arterial occlusive disease; OR
  • Nonviable limb; OR
  • To prevent progression to CLI

These are considered experimental/investigational as they are not identified as widely used and generally accepted for any other proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for PQ Bypass DETOUR System (0505T) or endovascular venous arterialization of the tibial or peroneal vein with transcatheter placement of intravascular stent graft(s) (0620T). These are considered experimental/investigational as they are not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for IVL for any indication. This technology is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Peripheral Artery Revascularization of the Lower Extremities
Effective Date: 02/02/2023
Revision Date: 02/02/2023
Review Date: 02/02/2023
Policy Number: HUM-0583-006
Page: 7 of 14

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Additional information about peripheral artery disease may be found from the following websites:

  • Background
    • American Heart Association
    • National Library of Medicine
    • Society of Vascular Surgery
  • Alternatives to endovascular treatment for peripheral artery disease include, but may not be limited to:
    • Medical Alternatives
      • Amputation
      • Peripheral artery bypass surgery

    Physician consultation is advised to make an informed decision based on an individual's health needs.

    Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes.

    Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.

    CPT® Code(s)
    Description
    Comments
    • 36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
    • 36246 Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family
    • 36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family

    Peripheral Artery Revascularization of the Lower ExtremitiesEffective Date: 02/02/2023 Revision Date: 02/02/2023 Review Date: 02/02/2023 Policy Number: HUM-0583-006 Page: 8 of 14

    Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

    CPT® Code(s)
    Description
    • 36248 Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)
    • 37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
    • 37221 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
    • 37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
    • 37223 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
    • 37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty
    • 37225 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
    • 37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
    • 37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed

    Peripheral Artery Revascularization of the Lower ExtremitiesEffective Date: 02/02/2023 Revision Date: 02/02/2023 Review Date: 02/02/2023 Policy Number: HUM-0583-006 Page: 9 of 14

    Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up to date version.

    Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

    CPT® Code(s)
    Description
    • 37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty
    • 37229 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
    • 37230 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
    • 37231 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
    • 37232 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
    • 37233 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
    • 37234 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
    • 37235 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)

    Peripheral Artery Revascularization of the Lower Extremities
    Effective Date: 02/02/2023
    Revision Date: 02/02/2023
    Review Date: 02/02/2023
    Policy Number: HUM-0583-006
    Page: 10 of 14

    Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

    Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

    Category Ill Code(s)
    Description
    Comments
    • O505T Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed, with crossing of the occlusive lesion in an extraluminal fashion - Not Covered
    • 0620T Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed - Not Covered
    • HCPCS Code(s)
    • C7531 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal angioplasty with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation - New Code Effective 01/01/2023
    • C7534 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with atherectomy, includes angioplasty within the same vessel, when performed with intravascular ultrasound (initial noncoronary vessel) during and/or - New Code Effective 01/01/2023

    Peripheral Artery Revascularization of the Lower Extremities
    Effective Date: 02/02/2023
    Revision Date: 02/02/2023
    Review Date: 02/02/2023
    Policy Number: HUM-0583-006
    Page: 11 of 14

    Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

    Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

    • C7535 femoral, popliteal artery(ies), unilateral, with transluminal stent placement(s), includes angioplasty within the same vessel, when performed, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation - New Code Effective 01/01/2023
    • C9764 Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed - Not Covered
    • C9765 Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed - Not Covered
    • C9766 Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed - Not Covered
    • C9767 Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel(s), when performed - Not Covered
    • C9772 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed - Not Covered
    • C9773 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed - Not Covered
    • C9774 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed - Not Covered

    Peripheral Artery Revascularization of the Lower Extremities
    Effective Date: 02/02/2023
    Revision Date: 02/02/2023
    Review Date: 02/02/2023
    Policy Number: HUM-0583-006
    Page: 12 of 14

    Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

    C9775 Revascularization, endovascular, open or percutaneous,
    tibial/peroneal artery(ies); with intravascular lithotripsy and /p v(ies); 1p Y - Not Covered

    References
    • American College of Cardiology (ACC). ACC/AHA/SCA/SIR/SVM 2018 appropriate use criteria for peripheral artery intervention. https://www.acc.org. Published 2019. Accessed January 17, 2023.
    • American College of Cardiology (ACC). Practice guidelines for the management of patients with peripheral artery disease. https://www.acc.org. Published 2013. Accessed January 17, 2023.
    • American College of Radiology (ACR). Appropriateness Criteria. Lower extremity arterial claudication-imaging assessment for revascularization. https://www.acr.org. Published 2016. Updated 2022. Accessed January 17, 2023.
    • American Heart Association (AHA). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. https://www.heart.org. Published March 21, 2017. Accessed January 17, 2023.
    • Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). Percutaneous transluminal angioplasty (20.7). https://www.cms.gov.

    Published March 11, 2013. Accessed January 13, 2023.

    ClinicalKey. Ashtiani A, Patel MP. Peripheral artery disease. In: Ferri F. Ferri’s Clinical Advisor 2023. Elsevier; 2023:1180-1186.e1. https://www.clinicalkey.com. Accessed January 13, 2023.

    ClinicalKey. Bonaca M, Creager M. Peripheral artery diseases. In: Libby P, Bonow R, Douglas L, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier; 2022:837-858. https://www.clinicalkey.com. Accessed January 13, 2023.

    Peripheral Artery Revascularization of the Lower Extremities
    Effective Date: 02/02/2023
    Revision Date: 02/02/2023
    Review Date: 02/02/2023
    Policy Number: HUM-0583-006
    Page: 13 of 14

    Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

    ECRI Institute. Clinical Evidence Assessment. Shockwave peripheral intravascular lithotripsy system (Shockwave Medical Inc.) for treating peripheral artery disease. https://www.ecri.org. Published January 13, 2017. Updated March 10, 2022. Accessed January 4, 2023.

    Hayes, Inc. Evolving Evidence Review. Intravascular lithotripsy for calcified peripheral arterial lesions. https://evidence.hayesinc.com. Published November 19, 2021. Accessed January 5, 2023.

    1. MCG Health. Femoral popliteal bypass. 26th edition. https://www.mcg.com. Accessed January 9, 2023.
    • MCG Health. Percutaneous revascularization, lower extremity. 26th edition. https://www.mcg.com. Accessed November 9, 2022.
    • Patel M, Conte M, Cutlip D et al. Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from peripheral academic research Consortium (PARC). J Am Coll Cardiol 2015;65(9):931-941. https://www.ncbi.nlm.nih.gov/pmc. Accessed January 17, 2023.
    • Society for Vascular Surgery. Global vascular guidelines on the management of chronic limb threatening ischemia. https://vascular.org. Published June 2019. Accessed January 17, 2023.
    • Society for Vascular Surgery. Guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. https://vascular.org. Published January 28, 2015. Accessed January 17, 2023.
    • Society for Vascular Surgery. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease. https://vascular.org. Published July 1, 2016. Accessed January 17, 2023.

    Peripheral Artery Revascularization of the Lower Extremities
    Effective Date: 02/02/2023
    Revision Date: 02/02/2023
    Review Date: 02/02/2023
    Policy Number: HUM-0583-006
    Page: 14 of 14

    Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

    16. UpToDate, Inc. Clinical features and diagnosis of acute lower extremity ischemia. https://www.uptodate.com. Updated December 2022. Accessed January 5, 2023.

    17. UpToDate, Inc. Endovascular techniques for lower extremity revascularization. https://www.uptodate.com. Updated December 12, 2022. Accessed January 5, 2023.

    18. UpToDate, Inc. Femoral artery aneurysm. https://www.uptodate.com. Updated December 2022. Accessed January 5, 2023.

    19. UpToDate, Inc. Management of chronic limb-threatening ischemia. https://www.uptodate.com. Updated December 2022. Accessed January 5, 2023.

    20. UpToDate, Inc. Management of claudication due to peripheral artery disease. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.

    21. UpToDate, Inc. Overview of lower extremity peripheral artery disease. https://www.uptodate.com. Updated December 2022. Accessed January 6, 2023.

    • UpToDate, Inc. Popliteal artery aneurysm. https://www.uptodate.com. Updated December 2022. Accessed January 6, 2023.
    • UpToDate, Inc. Surgical and endovascular repair of popliteal artery aneurysm. https://www.uptodate.com. Updated December 2022. Accessed January 6, 2023.
    • US Food & Drug Administration (FDA). 510(k) summary: Shockwave Medical peripheral intravascular lithotripsy (IVL) system. https://www.fda.gov. Published July 26, 2018. Accessed February 2, 2021.
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