ABSTRACT

Introduction Popliteal artery aneurysms (PAAs) are the most common peripheral arterial aneurysm and carry substantial risks of limb loss. Both open and endovascular repair are widely used, yet optimal patient selection remains uncertain. We evaluated institutional operative practices and examined associations between aneurysm morphology, procedural approach, and major adverse limb events (MALE).

Methods We conducted a retrospective cohort study at a tertiary care center to identify patients with PAAs from 2008–2022. Chart review confirmed aneurysm presence and captured demographics, comorbidities, medications, aneurysm characteristics, and operative details. Cox proportional hazards models were used to evaluate time to MALE defined as reintervention or amputation.

Results Among 330 PAAs, median follow-up was 7.4 months (IQR 3.4–12.7). Open repair comprised 79% (250/330), most often a medial approach (75%, 187/250) with autologous vein conduit (65%, 162/250). Open-repair patients were younger than endovascular (69 vs 74 years; p=0.006) with similar cardiovascular profiles. Indications differed by approach, with aneurysm size >20 mm most common for open repair (35.2%, 87/250) and mural thrombus most common for endovascular repair (33.3%, 24/80). MALE occurred in 30.3% (100/330). In univariate analyses, clopidogrel use was associated with increased MALE risk (HR 1.74, 95% CI 1.17–2.59; p=0.006), while descending aortic aneurysm was associated with decreased risk (HR 0.47, 95% CI 0.23–0.92; p=0.029). Operative approach, aneurysm diameter, and thrombus burden were not associated with MALE, and findings were unchanged after multivariable adjustment.

Conclusions MALE risk was comparable across operative strategies and aneurysm morphologies, suggesting that aneurysm size and thrombus burden alone should not preclude consideration of either open or endovascular repair.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This research was not supported by funding from any grant.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Mass General Brigham Human Research Committee Institutional Review Board approved the study protocol, and patient consent to participate was waived (IRB # 2019P003163).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

Data that were used in this study are available on request from the senior author (A.D.). Code to perform analyses in this manuscript are available from the authors upon request (A.D.).

AbbreviationsPAAsPopliteal artery aneurysmsCLICritical limb ischemiaALIAcute limb ischemiaTEThromboembolic eventPPVPositive predictive valueSVSSociety for Vascular SurgeryDUSDuplex ultrasoundSTROBEStrengthening the Reporting of Observational Studies in EpidemiologyMGBMassachusetts General BrighamRPDRResearch Patient Data RegistryAPAnteroposteriorCTAComputed tomography angiography