Postoperative Antithrombotic Therapy and Outcomes After Open Popliteal Artery Aneurysm Repair: A Multicenter Retrospective Cohort Study

Background Optimal postoperative therapy after poplital artery aneurysm (PAA) repair remains poorly defined with limited evidence mainly based on peripheral arterial disease (PAD) revascularization procedures. Aims To compare antithrombotic strategies and their impact on graft patency and survival following elective open PAA repair in a large multicenter cohort. Methods This multicenter retrospective study analyzed PARADE registry data from 40 centers in 10 European countries, including patients undergoing elective open posterior PAA repair between 2010 and 2023. Postoperative antithrombotic therapy was categorized as single (SAPT), dual antiplatelet (DAPT), direct/indirect anticoagulants, or combination therapy (CT). Primary outcomes were patency and survival, with secondary outcomes included secondary patency and major cardiovascular adverse events (MACE). Kaplan–Meier and Cox regression analyses were used. Results A total of 638 patients (median age 70 years; 96% male) were included, with a median follow-up of 30 months. Autologous vein grafts were used in 46.6% and prosthetic grafts in 50.7%. The most common postoperative regimen was SAPT (56.3%), followed by CT (17.7%), DAPT (14.4%), and anticoagulation alone (11.6%). Early outcomes showed 2.0% graft occlusion and 1.1% early MACE. Long-term survival was 90.3%. CT was linked to worse overall survival (HR 1.30, p=0.018). Primary patency at follow-up was 86.1%, with CT associated with increased risk of patency loss (HR 1.43). Similar results were seen for secondary patency. The overall MACE rate was 1.1%, with no differences between CT and other regimens. No significant differences were found between antiplatelet versus anticoagulant therapy, or between direct and indirect anticoagulants for all endpoints. Conclusion After open posterior PAA repair, intensified antithrombotic therapy combining anticoagulation and antiplatelet agents was associated with inferior survival and graft patency, without apparent benefit over simpler antithrombotic strategies.