Long-term outcome of endovascular popliteal artery aneurysm repair

Objective: The position of endovascular treatment in the algorithm of popliteal artery aneurysm (PAA) repair is still a matter of debate. Although several studies have described results similar to those of open surgery, follow-up of the endovascular group has been relatively short so far. The aim of this study was to describe the long-term outcome of endovascular repair of PAA with endografts. Methods: All patients with a PAA treated with an expanded polytetrafluoroethylene stent graft between June 1998 and November 2014 in a tertiary referral center were prospectively gathered in a database and retrospectively analyzed. The primary end point of this study was primary patency. Secondary end points included primary assisted and secondary patency, survival of the patient, stent fractures, secondary interventions, and limb loss. Results: A total of 75 PAA5 were treated in 64 patients with a mean age of 68.1 +/- 9.4 years. Unilateral PAA was present in 39 patients (61%) and bilateral PAA5 in 25 patients (39%), of which 11 (17%) were treated bilaterally. Median follow-up was 68 months (range, 2-187 months). Primary patency at 1 year, 5 years, and 10 years was 84%, 60%, and 51%, respectively; primary assisted patency, 84%, 65%, and 57%; and secondary patency, 89%, 71%, and 60%. Stent fractures occurred in 28% of the cases (n = 21) in a median follow-up time of 47 months (range,14-187 months). One-third of the fractures were associated with an occlusion that mainly presented with claudication, and only one was associated with acute ischemia. Reinterventions were performed in 12 cases (16%) during a median follow-up of 14 months (range, 1-47 months). The reintervention-free survival after 1 year, 5 years, and 10 years was 93%, 79%, and 79%, respectively. No major amputations were performed. The overall survival rate after 5 years and 10 years was 78% and 46%, respectively. Conclusions: Endovascular repair has established a definitive role in the treatment protocol for PAA5. It is associated with acceptable long-term patency rates. Stent fractures occurred in almost one-third of cases but never led to limb loss. Future developments should focus on the design of more dedicated and durable stents for this specific indication.