title: Open repair of asymptomatic popliteal artery aneurysm is associated with better outcomes than endovascular repair.
abstract: OBJECTIVE
  Open (OPAR) and endovascular (EPAR) repair are both used to treat popliteal artery aneurysm (PAA). We assessed outcomes of both modalities in the treatment of asymptomatic PAAs.
  
  
  METHODS
  Vascular Quality Initiative (VQI) databases (2010 to 2013) were queried for patients undergoing asymptomatic PAA repair using OPAR and EPAR. The groups were compared with respect to demographics, medical history, and procedural characteristics. Outcomes of interest were length of stay (LOS), major adverse limb events (MALE), MALE or perioperative death (MALE-POD), and loss of primary patency compared using Kaplan-Meier estimates. Proportional hazard Cox regression was used to compare the outcomes across the treatment groups. Multivariable regression with backward elimination procedure (α = .5) was used to construct parsimonious models to predict MALE and MALE-POD. Gamma regression was used to compare LOS.
  
  
  RESULTS
  From 2010 to 2013, 390 patients with asymptomatic PAAs were identified (221 OPAR, 169 EPAR) and included in this study. Preoperative comorbidities were similar between the two groups, except for a higher rate of congestive heart failure (19.5% vs 11.8%, P = .042) and chronic obstructive pulmonary disease (19.5% vs 11.8%, P = .042) in the EPAR group. No in-hospital mortality was observed. LOS was significantly longer in the OPAR group (3.8 ± 2.5 vs 1.4 ± 1.9 days; P < .001). OPAR patients had a significantly higher MALE-free survival (95% vs 80%; P < .001) as was MALE-POD-free survival (93% vs 80%; P < .001) rates at 1 year after the procedure. OPAR was associated with lower hazard of MALE (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.15-0.86; P < .05), MALE-POD (HR, 0.28; 95% CI, 0.13-0.63; P < .05), and primary patency loss (HR, 0.25; 95% CI, 0.10-0.58; P < .05).
  
  
  CONCLUSIONS
  This retrospective analysis suggests that OPAR is associated with better outcomes than EPAR. Ultimately, the ongoing, adequately powered Open versus Endovascular Popliteal Artery Aneurysm Repair (OVERPAR) trial will definitively compare these procedures.
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass. Electronic address: mohammad.eslami@bmc.org.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
authors.affiliation: Department of Biostatistics, Boston School of Public Health, Boston, Mass.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Department of Biostatistics, Boston School of Public Health, Boston, Mass.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D058070:Asymptomatic Diseases; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011150:Popliteal Artery / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency