Long Term Follow Up after Endovascular Popliteal Artery Aneurysm Repair: A Two Centre, Retrospective Cohort Study (1998 - 2023)

Abstract

Objective: The aim of this study was to evaluate the long term outcomes of endovascular popliteal artery aneurysm repair (EPAR).

Methods: This two centre, retrospective cohort study included elective EPAR procedures (1998 - 2023) and followed STROBE guidelines. Outcomes included patency rates as well as re-intervention free survival, complications, and overall survival. Kaplan-Meier analyses were used to assess patency and survival, handling missing data via censoring. Cox regression was used to analyse risk factors. Patients generally received dual antiplatelet therapy post-intervention.

Results: A total of 149 popliteal artery aneurysms (PAAs) were treated, of which 26 were excluded due to pseudoaneurysm (n = 4), lack of follow up (n = 4), enrolment in the objection registry (n = 3), or acute presentation (n = 15, except for two contralateral elective treatments). The final cohort included 123 elective PAAs in 105 patients (96.2% male; mean age 70.1 ± 8.8 years). The median follow up was 57 months (interquartile range 25, 114). Primary patency rates at one, five, ten, and 15 years were 78%, 54%, 42%, and 31%, respectively. Primary assisted and secondary patency rates at 15 years were 35% and 45%. Late complications occurred in 70 PAAs (56.9%), including 46 (37.4%) occlusions. There were 40 acute consultations, involving 28 PAAs, requiring urgent repair in 34 (85%). Of 52 re-interventions, 65% were acute and occurred statistically significantly earlier than non-acute re-interventions (27 ± 43 months vs. 71 ± 62 months; p < .001).

Conclusion: Long term outcomes indicate a lower patency rate for EPAR compared with the literature on the same stent type and open repair. However, interpretation should consider the retrospective design, use of two stent types, and potential statistical bias. The high rate of acute occlusions suggests that close follow up alone may be insufficient to prevent complications.

Keywords: Aneurysm; Endovascular aneurysm repair; Peripheral arterial disease; Popliteal artery aneurysm.