Outcome of Open and Endovascular Repair in Patients with Acute Limb Ischemia Due to Popliteal Artery Aneurysm

Background: Popliteal artery aneurysm (PAA) carries a risk of sudden thromboembolism, resulting in acute limb ischemia (ALI). Since 2010, all 65 year-old-men in Region Skane are invited for abdominal aortic aneurysm (AAA) screening, and subsequently for PAA if AAA is detected. The aims of the study were to explore if the ratio of PAAs treated electively compared with acute has changed since the implementation of the AAA screening program and to investigate the risk factors for major amputation, mortality, and combined major amputation/mortality after acute open repair (OR) or endovascular repair (ER) for PAA with ALI. Method: Medical charts of patients treated for PAA between January 1, 2009 and February 1, 2019 were identified by the International Classification of Diseases, 10th revision code 172.4. Data gathered into a preset database. A multivariable Cox regression analysis was used to identify independent risk factors for major amputation/mortality. Results: There was an increase in PAAs treated electively (n = 84) compared with acute (n = 41) during the study period (P = 0.014). Four (17.8%) electively treated patients with PAA of 23 eligible were detected because of AAA screening. No patient in the ER group underwent major amputation after a median follow-up time of 30 months. At the end of follow-up, there was no difference in major amputation/mortality (P = 0.64) between patients with ALI receiving OR or ER, respectively. Only atrial fibrillation was identified as an independent risk factor for mortality (P = 0.003). Conclusions: The increase in elective PAA repair was not a consequence of AAA screening. The zero major amputation rate after ER in ALI due to PAA at mid-term was unexpectedly low. A randomized controlled trial between OR and ER is warranted.