Popliteal artery aneurysms (PAA) need urgent treatment in the rare cases of acute thrombosis, distal embolization or rupture, however only few data are available in the literature about the results of treatment in the different scenarios. The aim of the present study was to evaluate an 11 year -multicenter experience in the urgent treatment of PAA.

All patients surgically treated for PAA in two high-volume vascular centers were considered. Patients were enrolled prospectively from 2010 to 2021 evaluating clinical presentation, anatomical characteristics and technical surgical aspects. The main aim was to evaluate the outcome of urgent PAA (uPAA) treatment according to their clinical presentation, i.e. PAA thrombosis, peripheral embolization and PAA rupture. The follow-up was performed by annual clinical and duplex-ultrasound evaluation. Statistical analysis was performed by Kaplan Meier log-rank evaluation and multivariable Cox regression tests.

Of a total of 390 PAA treated in the study period, 66 (17%) needed an urgent treatment. The mean age was 72±11 years; all patients were males with a mean PAA diameter of 39±19 mm; 12 (18%) had a PAA rupture and 54 (82%) had an acute limb ischemia due to either distal embolization (23 / 35%) or acute PAA thrombosis (31 / 47%) cases. Patients with PAA rupture were older (82±9 vs 69±10 year-old, P=.01) and were generally treated with a prosthetic graft 11/12 (92%). Patients with acute limb ischemia (Rutherford class IIa and IIb) were treated with bypass surgery in 51 (94%) cases, which was associated with intra-arterial thrombolysis in 18 (31%) cases. The bypass was performed with great saphenous vein in 20 (39%) cases. A primary major amputation was performed in 3 (6%) cases. The mean follow-up was 52±21 months with an overall 5-year limb salvage of 80±7%. The limb salvage during the follow-up was influenced only by the number of patent tibial arteries (pTA), with 0% limb salvage at one year in patients with no pTA, and 85±13%, 92±8% and 100% limb salvage in case of 1, 2 or 3 pTA at 5-year follow-up, respectively (P=.001). The clinical presentation or the graft material of the bypass were not associated to limb loss during the follow-up. Cox regression confirmed the independent association of number of pTA and limb loss during the follow-up [hazard ratio (HR): 0.14 (95% confidence interval (CI) 0.03-0.6), P=.001]. The overall 5-year survival after uPAA treatment was 70±7%. Ruptured PAAs were associated with a lower 5-year survival compared with patients treated for acute ischemia (37±16% vs. 79±7%, P=.001); similarly, the number of pTA (33±27%, 65±14%, 84±10% and 80±10% for 0,1,2 and 3 pTA respectively, P=.001) and the thrombolysis were associated with a higher survival in patients with acute limb ischemia ( 94±6% vs. 72±10%, P=.03). Cox regression confirmed the independent association of number of pTA and survival during the follow-up [HR 0.15 (95% CI: 0.03-0.8), P=.03].

PAA rupture is the cause of urgent PAA treatment in almost one fifth of cases, and has negative effect on late survival. Acute limb ischemia can benefit from thrombolysis therapy, and the limb salvage and survival during the follow-up is strictly associated to the number of pTA.