Late Longitudinal Comparison of Endovascular and Open Popliteal Aneurysm Repairs

We sought to define suitable anatomy predicting durable exclusion of popliteal artery aneurysms (PAAs) and define optimal patient selection criteria for endovascular repair (ER).

Seventy-five PAAs were repaired in 66 patients (64 male and 2 female) over the past 13 years. Fifty-two aneurysms (69%) were treated with open surgical exclusion and/or bypass using autologous vein (69%) or polytetrafluorethylene (31%) conduit. Extended bypass targets required inflow from the common femoral artery in 15% of limbs and outflow via a tibial artery in 31%. Since May 2001, ER was considered in patients with high medical risk, limited vessel tortuosity, absence of significant occlusive disease (ankle-brachial index > 0.9), and PAA not involving below knee segments. Interventions were performed via antegrade femoral access in 23 limbs (31%) using commercially available endografts. Device diameters ranged between 7 and 13 mm, with a median of 2 devices per PAA, and mean treatment length was 22 cm (range, 5-36 cm). All patients were followed with duplex ultrasound surveillance and were prescribed clopidogrel and/or aspirin.

Patients treated endovascularly were older (82 vs. 70 years old, P = 0.01), but had shorter length of stay (2 vs. 12 days, P = 0.01) and lower complication rates (8% vs. 17%, P = 0.02). Mean surveillance interval was 39 months with similar 4-year survival (67.9% open and 73.7% endovascular). Primary and secondary patencies were 67.2%, 67.2% after ER and 65.5%, 78.4% for open at 4 years, respectively. Four of 6 endovascular failures were thrombosis within 4 months of intervention and had conversions to open repair (OR). Secondary interventions were required after 48.1% of endovascular and 54.1% of ORs. Three limbs were lost in the series (2 open and 1 endovascular).

Similar outcomes can be expected after endovascular and open PAA repair with adherence to specific anatomic and technical selection requisites.