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Size, Thrombus Burden Prove Useful as Criteria for Operative Repair of PAA

Synopsis by Lewis Flint, MD, FACS

June 17, 2025

acs-store-journalperiodical.jpg

Bellomo TR, Goudot G, Srihari KL, et al. Natural History of Popliteal Artery Aneurysm: Evaluating Percent Thrombus and Size Threshold for Operative Management. J Am Coll Surg. 2025, in press.

Popliteal artery aneurysm (PAA) is the most common peripheral artery aneurysm, and current recommendations for management of these aneurysms are based solely on aneurysm size. Recent data have suggested that aneurysm size may not be the only variable that correlates with rates of thromboembolic events or need for emergency surgery.

This retrospective cohort study (131 PAA in 114 patients) defined an adverse event as a composite of critical limb ischemia, acute limb ischemia, aneurysm rupture, thromboembolic event, or amputation. Patients underwent medical therapy and were followed for a median of 7.4 months.

Aneurysm size (threshold of 17.7 mm) and higher percent thrombus burden (threshold of 59% confirmed with ultrasonography) showed positive predictive value for an adverse event of 94.1% and 80.6%, respectively.

The authors recommended using aneurysm size and thrombus burden as criteria for operative repair of PAA.

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