Clinical Outcomes of Open Repair for Small Popliteal Artery Aneurysms

Indications for surgical repair of <20 mm popliteal artery aneurysms (PAAs) remain uncertain. Although the SVS recommends intervention for symptomatic small PAAs (sPAAs), clinical outcomes are poorly characterized. We evaluated the perioperative and long-term results of open repair for sPAAs.

This multicenter retrospective cohort study included 34 patients (40 limbs) who underwent open surgery for PAAs between January 2009 and December 2024 at 2 Japanese vascular surgery centers. The sPAA group (maximal diameter <20 mm) was compared with the large PAA group (LPAA; maximal diameter ≥20 mm). Baseline characteristics, operative details, graft patency, limb salvage, and survival were analyzed. Patients requiring primary amputation due to Rutherford III acute ischemia were excluded.

Eleven of 40 limbs (27.5%) were classified as sPAA. All limbs in the sPAA group were symptomatic, presenting with acute lower limb ischemia (n = 4), claudication (n = 6), or toe gangrene (n = 1). The median maximal aneurysm diameter was 17.0 mm in the sPAA group and 32.0 mm in the LPAA group. Thrombus occupancy tended to be greater in the sPAA group than in the LPAA group (86.1% vs. 74.9%). Operative approach, graft choice, operative time, blood loss, and length of hospital stay were comparable between the groups. Five-year limb salvage (100% vs. 89.2%; P = 0.264), overall survival (86.1% vs. 84.0%; P = 0.904), primary patency (90.9% vs. 84.6%; P = 0.795), and secondary patency (100% vs. 95.0%; P = 0.480) did not differ significantly between the groups.

Open repair of symptomatic sPAA group demonstrated favorable outcomes comparable to those of LPAA group. Surgical intervention should be considered for symptomatic sPAA, particularly when thrombus burden is present.