ASSOCIATE PROFESSOR OF VASCULAR SURGERY University of Pisa
Objectives: Optimal postoperative antithrombotic therapy after open repair of popliteal artery aneurysms (PAAs) remains undefined, with current recommendations largely extrapolated from peripheral arterial disease studies. This study compared postoperative antithrombotic strategies and their association with graft patency and survival following elective open posterior PAA repair.
Methods: This multicenter retrospective cohort study analyzed data from the PARADE registry, including 40 vascular centers across 10 European countries. Consecutive patients undergoing elective open posterior PAA repair between January 2010 and December 2023 were included; endovascular repairs were excluded. Postoperative antithrombotic therapy was classified as single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), oral anticoagulation (OAC or DOAC), or combination therapy (CT: anticoagulant plus antiplatelet). Primary outcomes were long-term primary patency and overall survival. Secondary outcomes included secondary patency and major adverse cardiovascular events (MACE). Kaplan–Meier analysis and multivariable Cox regression were used.
Results: A total of 638 patients were included (median age 70 years; 96% male), with a median follow-up of 30 months. Autologous vein grafts were used in 46.6% of cases and prosthetic grafts in 50.7%. SAPT was the most common postoperative regimen (56.3%), followed by CT (17.7%), DAPT (14.4%), and anticoagulation alone (11.6%). Early outcomes were favorable, with 2.0% early graft occlusion and 1.1% early MACE. Long-term overall survival was 90.3%. Combination therapy was independently associated with worse overall survival compared with all other regimens (HR 1.30, p=0.018). Primary patency at follow-up was 86.1%, with CT associated with a significantly increased risk of primary patency loss (HR 1.43). Similar findings were observed for secondary patency. Overall MACE rate was 1.1%, with no differences between patients under CT versus others. No significant differences were observed between antiplatelet versus anticoagulant therapy alone, nor between OAC and DOAC for all the endpoints.
Conclusions: After open posterior PAA repair, intensified antithrombotic therapy combining anticoagulation and antiplatelet agents was associated with inferior graft patency and survival, without apparent benefit over simpler antithrombotic strategies.
