Percent Thrombus Predicts Popliteal Artery Aneurysm Related Limb Threatening Events

The objective of this study was to identify clinical and anatomic characteristics of Popliteal artery aneurysms (PAAs) associated with acutely limb-threatening events.

Popliteal artery aneurysms (PAAs) are associated with high morbidity and mortality. Current guidelines recommend operative repair for PAAs with a diameter greater than 20 mm based on very limited evidence.

This retrospective cross-sectional cohort was derived from a multi-institutional database queried for all patients with a PAA from 2008 to 2022. Duplex ultrasound characteristics of PAAs were abstracted by registered physicians in vascular interpretation. Symptom status at the time of duplex ultrasound was divided into 3 categories: asymptomatic PAA, symptomatic PAA with claudication or chronic limb ischemia, and acutely limb-threatening PAAs with a thromboembolic event, acute limb ischemia, or rupture.

There were 470 PAAs identified in 331 patients. The mean age was 74 years at diagnosis; 94% of patients were white, and 97% of patients were male. In a univariate analysis, patient comorbidities and medications were not associated with symptom status. In a multivariate analysis including age, a higher percent thrombus was significantly associated with symptomatic PAAs (RRR 15.2; CI: 2.69-72.3; P<0.01) and PAAs with an acutely limb-threatening event (RRR 17.9; CI: 3.76-85.0; P<0.01). All other anatomic characteristics were not associated with symptom status.

Percent thrombus was significantly associated with symptomatic PAAs and acutely limb-threatening events, whereas diameter was not significantly associated with any symptom group. This analysis supports the use of percent thrombus in identifying high-risk PAAs that warrant repair.