IFT09 - A case-control study on open and endovascular management of popliteal artery aneurysms

Objectives: The aim of this retrospective monocentric case-control study was to compare early and long term results of open and endovascular management of popliteal artery aneurysms (PAAs).

Methods: From January 1995 to December 2022 364 consecutive interventions were performed for PAA in 291 patients. Of these, 280 were performed by open surgery and 84 by endovascular technique. Operations performed with endovascular surgery were matched to those performed with open surgery using a one-to-one Coarsened Exact Matching (CEM) generating a matching control group. The two groups (endovascular group, ER, 83 interventions; open surgery group, OR, 83 interventions) were compared in terms of perioperative outcomes (mortality, thrombosis, and amputation at 30 days) using χ2 test. Follow-up data were analyzed with Kaplan-Meier curves in terms of survival, primary patency, secondary patency, limb salvage, reintervention-free survival (RFS) and amputation-free survival (AFS). and the results in the two groups were compared by log-rank test.

Results: In the original dataset, patients in the endovascular group were older and had a worse outflow vessel status than patients in the open group, while the latter had symptomatic and thrombosed aneurysm more frequently. After matching, the aneurysm was symptomatic in 25 cases in the ER group and in 26 cases in the OR group. The mean postoperative hospital stay was 3.2 ± 1.1 days in the ER group and 5.7 ± 3.3 days in the OR group (p < 0.001). There were no differences between the two groups in terms of perioperative outcomes. Namely, the composite rate of death and amputation was 2.4% in the OR group and 3.6% in the ER group (p=0.7).
Median duration of follow-up was 44 months. The estimated 8-year survival was 88% in the OR group and 71.5% in the ER group (p=0.2; log rank 1.3); primary patency rates at 8 years were 59% in the OR group and 66% in the ER group (p=0.5, log rank 0.3). Overall, the 8-year RFS was 60% in the OR group and 67% in the ER group (p=0.2, log rank 1.7). The secondary patency at 8 years was 60.5% in the OR group and 65.5% in the ER group (p=0.4, log rank 0.5). Eight-year AFS was 75% in the ER group and 69% in the ER group (p=0.6, log rank 0.2).

Conclusions: In our 25-year experience, both open and endovascular surgery for popliteal artery aneurysms yielded excellent results. We prioritize endovascular treatment, reserving open surgery for complex cases and high-risk patients.