Outcomes of endovascular and contemporary open surgical repairs of popliteal artery aneurysm

Abstract

The purpose of this study was to compare outcomes after endovascular repair (ER) and contemporary open repair (OR) of popliteal artery aneurysms (PAAs). Clinical data of PAA patients treated between 2005 and 2012 were reviewed. Primary end points were major adverse events (MAEs) including mortality, major amputation, patency, complications, and reinterventions. A total of 149 PAAs were treated in 120 patients (mean age, 74 ± 10 years). ER was performed in 42 limbs of 35 men (mean age, 81 ± 6.5 years), in 32 electively and in 10 emergently. Technical success was 98%. The 30-day MAEs were more frequent after emergent repair (50% vs 9%; odds ratio [OR], 9.67; 95% confidence interval [CI], 1.74-54; P = .01); mortality and amputation rate was 0% after elective repair, 20% after emergent repair. Mean follow-up was 2.6 years (1 month-6.5 years); 3-year freedom from MAEs was lower after emergent repair than after elective repair (40% vs 66%; hazard ratio [HR], 3.13; 95% CI, 1.10-8.85; P = .03). OR was performed in 107 limbs of 91 patients (90 men; mean age, 71 ± 9.6 years), in 93 electively and in 14 emergently. The 30-day MAEs were more frequent after emergent repair (43% vs 5%; OR, 13; 95% CI, 3.29-53; P < .001); mortality was 1% after elective repair, 0% after emergent cases. Amputation rate was 0% for both elective and emergent repairs. Mean follow-up was 3.8 years (1 month-8.4 years); 3-year freedom from MAEs was lower after emergent repair (50% vs 80%; HR, 3.78; 95% CI, 1.55-9.20; P = .003). The 30-day MAE rates were equivalent between ER and OR independent of urgency of repair (elective: OR, 1.82; 95% CI, 0.41-8.09; P = .43; emergent: OR, 1.33; 95% CI, 0.26-6.81; P = .73). In elective interventions, ER had a trend to decreased freedom from MAEs (66% vs 80% at 3 years; HR, 1.93; 95% CI, 0.92-4.07; P = .08); freedom from reintervention was lower after ER (72% vs 88%; HR, 2.41; 95% CI, 1.02-5.70; P = .046). In emergent interventions, 1-year freedom from MAEs was similar (40% vs 50%; HR, 1.36; 95% CI, 0.49-3.74; P = .55). Emergent ER and poor runoff predicted MAEs. Our study failed to prove the superiority of ER over OR. If anatomy is suitable, ER of PAA in the elderly and high-risk patients is justified. For emergent PAA repairs, MAEs are frequent after both ER and OR; ER has not changed the severe prognosis of acute limb ischemia from PAA. A multicenter randomized controlled trial of PAA patients with acute presentation is warranted.