Endovascular Revascularization Followed by Isolated Popliteal Artery Decompression for Popliteal Artery Entrapment Syndrome: A Multicenter Retrospective Comparative Study.

BACKGROUND

Popliteal artery entrapment syndrome (PAES) is a rare vascular disorder caused by extrinsic compression of the popliteal artery, which may progress to fixed stenosis, occlusion, or thrombosis. Conventional open decompression combined with surgical revascularization remains the standard treatment for anatomical PAES with structural arterial lesions but is associated with considerable surgical invasiveness. This study aimed to evaluate the feasibility and short-term outcomes of a staged endovascular-first strategy combining endovascular revascularization with isolated popliteal artery decompression.

METHODS

A multicenter retrospective analysis was conducted on patients with anatomical PAES complicated by fixed popliteal artery stenosis or occlusion requiring revascularization between January 2019 and October 2024. Patients were divided into a staged group (initial endovascular revascularization followed by delayed open decompression) and an open group (single-stage open decompression with surgical revascularization). Perioperative outcomes, ankle-brachial index (ABI), symptom relief, complications, and 1-year primary patency were compared.

RESULTS

Baseline characteristics and lesion features were comparable between groups. Compared with the open group, the staged group demonstrated significantly reduced intraoperative blood loss (32.0 ± 23.9 mL vs. 54.6 ± 31.1 mL, P = 0.042), shorter general anesthesia time (2.4 ± 0.5 h vs. 3.8 ± 0.7 h, P < 0.01), and smaller incision length (9.6 ± 1.4 cm vs. 14.0 ± 2.2 cm, P < 0.01), while operative duration and length of hospital stay were similar. Postoperative ABI improved significantly in both groups, with no intergroup difference at discharge (0.98 ± 0.12 vs. 0.96 ± 0.17, P > 0.05). During a mean follow-up of approximately 22 months, symptom relief rates were comparable (90.9% vs. 87.0%, P = 0.738). Kaplan-Meier analysis showed comparable 1-year primary patency between the staged and open groups (90.9% vs. 95.7%; log-rank P = 0.605).

CONCLUSION

In carefully selected patients with anatomical PAES and fixed arterial lesions, a staged strategy combining endovascular revascularization with isolated popliteal artery decompression appears to be a safe and feasible minimally invasive alternative, with short-term clinical outcomes and vessel patency comparable to conventional open surgery. Further prospective studies with larger cohorts and longer follow-up are warranted.