Treatment of popliteal artery injuries: a comparison of application patterns and short-term outcomes between open surgical and endovascular repair

After femoral artery injury, popliteal artery injury (PAI) is the second most frequent form of arterial injury in the lower extremities. Its exceptionally high risk of limb loss has attracted a lot of attention in the field of acute lower extremity vascular damage. Nowadays, open surgical repair or endovascular surgical repair are the main methods used to treat popliteal artery damage due to developments in medical technology. The effectiveness and complication rates of these two surgical techniques are still hotly debated, though, and there is a lot of room for advancement in this field. The purpose of this study was to compare the clinical effectiveness of endovascular surgery versus open surgery for PAI, list the benefits and drawbacks of each procedure, and offer recommendations for clinical decision-making. This single-center retrospective cohort study (2022–2024) enrolled 140 patients with peripheral arterial injury (PAI) who underwent surgical treatment at our institution. Participants were stratified into two groups according to surgical approach: endovascular repair (n = 41) and open surgical repair (n = 99). The following parameters were analyzed and compared between groups: limb salvage rate, intraoperative blood loss, operative duration, preoperative and postoperative Visual Analog Scale (VAS) scores, complication rates, and secondary intervention rates. The prespecified primary endpoint was the 6-month limb salvage rate. All statistical analyses were performed using SPSS version 27.0, with a P value < 0.05 considered statistically significant. The open surgery repair group experienced an intraoperative blood loss of 464.60 ± 120.78 ml and an average surgical length of 128.89 ± 34.65 min. The postoperative follow-up short-term patency rates at 1, 3, and 6 months were 90.91%, 85.86%, and 78.79%, respectively, and the preoperative VAS score was 6.99 ± 1.42 and the postoperative VAS score was 3.48 ± 1.12. The endovascular repair group experienced an intraoperative blood loss of 175.46 ± 138.33 ml and an average surgery duration of 104.34 ± 27.58 min. Both the preoperative and postoperative VAS scores were 7.29 ± 1.36 and 3.02 ± 1.33, respectively. Short-term patency rates were 87.80%, 82.93%, and 73.17% at 1, 3, and 6 months after surgery, respectively. Vascular short-term patency rates at six months did not differ significantly between the two groups (P > 0.05), although there were significant variations in surgical length, blood loss, and postoperative VAS ratings (P < 0.05). The open surgery group experienced an overall complication rate of 27.27% and an amputation rate of 10.10%. The endovascular surgery group experienced an overall complication rate of 21.95% and an amputation rate of 4.88%. The two groups did not differ significantly in terms of problems (P > 0.05). This study shows similar limb salvage and short-term patency between endovascular and open repair for popliteal artery injuries. Endovascular approach offers minimally invasive benefits without reducing complications. The retrospective design risks bias and limits follow-up, with open repair possibly including more complex cases. These findings should be confirmed through prospective multicenter trials with standardized outcomes.