Popliteal artery aneurysm repair with endovascular stent grafting matches surgical bypass at a cost of higher reintervention burden over a 16-year experience.

OBJECTIVE

To compare long-term outcomes of open and endovascular repair for popliteal artery aneurysms (PAAs) and identify factors associated with patency and limb loss.

METHODS

A retrospective review of all PAAs treated from 2008 to 2024 across a single health care system was conducted with comparison of endovascular and open surgical repair techniques. Long-term outcomes (≥5 years) included primary, primary-assisted, and secondary patency, major adverse cardiac events, major adverse limb events (MALE), freedom from reintervention, freedom from major amputation, and all-cause mortality. Statistical analysis was done with Kaplan-Meier, Fisher's exact test, t-tests, χ2, negative binomial regression, Mann-Whitney U test, Breslow's test, and Cox proportional hazards utilizing SPSS.

RESULTS

A total of 222 limbs in 183 patients underwent PAA repair, including 171 open and 51 endovascular repairs. Patients were followed for a mean of 47.9 ± 41.6 months, with similar median lengths of follow-up between the endovascular and open repair groups (median, 36.0 months [interquartile range (IQR), 8.7-57.1 months] vs 37.4 months [IQR, 13.9-75.2 months]; P = .207) respectively. Endovascular repair patients had shorter hospital length of stay (1 days [IQR, 0-1 days] vs 3 days [IQR, 2-5 days]; P < .001), and experienced significantly higher cumulative reinterventions per limb (incidence rate ratio, 1.70; 95% confidence interval [CI], 1.05-2.73; P = .003). Freedom from reintervention did not differ significantly between repair methods (P = .064); however, the Breslow test reached significance (P = .045), suggesting that endovascular repairs experienced a greater frequency of early reintervention events. Primary patency in the open and endovascular repair groups at 1, 3, and 5 years was (79.8% vs 72.1%, 70.8% vs 58.5%, and 67.3% vs 58.5%; P = .036), respectively, but there were no significant differences in primary-assisted and secondary patency, and freedom from major amputation at 1, 3, and 5 years (98.1% vs 98.0%, 97.3% vs 95.4%, and 96.1% vs 95.4%; P = .489). On multivariate analysis, endovascular repair demonstrated a trend toward increased risk of 1-year loss of primary patency (hazard ratio [HR], 1.97; 95% CI, 0.98-3.93; P = .056) and independently predicted 1-year MALE (HR, 2.06; 95% CI, 1.02-4.17; P = .045).

CONCLUSIONS

Endovascular and open repair of PAAs offer comparable long-term primary-assisted and secondary patency as well as limb salvage. Endovascular repair is associated with a shorter hospital length of stay but lower primary patency, higher reintervention burden, and higher MALE at 1 year. Technique selection should consider patient comorbidities and symptomatology to optimize surgical outcomes.