Open Versus Endovascular Repair of Patent Popliteal Artery Aneurysms in an Elective Setting: A Multicenter Retrospective Study with Long-Term Follow-Up

Background: The aim of this study is to investigate long-term outcomes of open repair (OR) versus endovascular popliteal aneurysm repair (EPAR) for popliteal artery aneurysms (PAAs) in an elective setting. Methods: A retrospective analysis was performed on all patients treated for a popliteal aneurysm with OR and EPAR between 2010 and 2020 in 2 high-volume centers. Primary endpoints were freedom from amputation and overall patency. Secondary endpoints included secondary patency, reinterventions rates and predictors of late failure. Follow-up protocol included clinical examination and duplex ultrasound at 1, 6, 12 months, and annually thereafter. The Chi-square test was used to assess differences in categorical outcomes and Student's t-test in continuous outcomes. A P value of less than 0.05 was considered statistically significant. Results: Between 2010 and 2020, 143 limbs from 120 patients were treated for PAA in an elective setting: 70 limbs with OR and 73 with EPAR. Primary patency at 1, 3, and 5 years were 92.7%, 92.7%, and 81% for OR and 77.3%, 67.9%, and 64.1% for EPAR respectively (P = 0.01). There was a significant difference in terms of 1-year patency for patients with 2–3 runoff vessels between OR and EPAR (96.1% vs. 82.7 respectively, P = 0.03). Reintervention rate was different between the groups with freedom from reintervention at 1, 3, and 5 years all of 95.7% for OR and 82.2%, 70.9%, and 70.9% for EPAR (P = 0.02). The 1-, 3-, and 5-year secondary patency did not differ between the groups and was 100%, 97.6%, and 90.6% for OR and 94%, 91.3%, and 88.4% for EPAR (P = 0.3). Freedom from amputation was excellent for both groups (100% for OR and 99% for EPAR, P = 0.5). The presence of 2–3 runoff vessels was a relevant protective moderator with a relative risk of 0.6 (P = 0.08). Conclusion: OR and EPAR are comparable therapeutic options for the treatment of asymptomatic PAAs in terms of secondary patency and freedom from amputation despite an increasing rate of late occlusions and reintervention in EPAR group. The difference in primary patency between the 2 techniques seems more significant within the first-year of follow-up for those patients with a better runoff.