Mid and Long-Term Outcomes of Externally Stented Vein Grafts for Popliteal Aneurysm Repair

Popliteal artery aneurysms (PAAs) may result in limb-threatening acute or chronic ischemia if left untreated. Open repair remains the gold standard, with durable long-term outcomes, particularly when an autologous vein graft is available. The FRAME™ external vein graft stent (FEVGS) has been developed to limit vein graft dilatation and maintain favorable hemodynamic conditions over time. This study aims to evaluate the mid- and long-term outcomes of externally stented vein grafts for popliteal aneurysm repair.

Patients undergoing urgent or elective open PAA repair with FEVGS implantation were included in a single-center, retrospective observational cohort study. Clinical and duplex ultrasound follow-up was performed before discharge, at 3 and 6 months, and annually thereafter. The primary outcome was vein graft patency; secondary outcomes included mean graft lumen diameter, intimal hyperplasia, and overall survival. Analyses were performed using descriptive statistics and Kaplan-Meier estimates.

Between December 2017 and December 2023, 30 patients (32 limbs) were included. A medial approach was used in 87.5% of the cases, and a non-reversed great saphenous vein graft was used in 87.5%. Acute limb ischemia was the presenting condition in 46.9% of the cases, and no trophic lesions were observed. Limb salvage was 100%. Primary patency was 93.2% at 12 months and 84.6% at 36 months. Assisted primary patency was 93.2% at 12 months and 84.7% at 36 months, while secondary patency was 90.9% at 36 months. Mean graft diameter and intimal hyperplasia remained stable over time. Overall survival was 75.8% at 36 months and 55.2% at 48 months.

Open PAA repair with FEVGS implantation was associated with satisfactory patency rates and stable vein graft morphology over time. These findings suggest that FEVGS may contribute to maintaining graft integrity and represents a safe and durable option in open PAA repair.