Abstract:Background and Aims Popliteal artery aneurysm (PAA) is the most common peripheral arterial aneurysm and may result in acute limb ischemia due to thrombosis or distal embolization. Evidence regarding the clinical characteristics and long-term outcomes of PAA in Chinese populations remains limited. This study aimed to evaluate the clinical features, treatment strategies, and long-term outcomes of surgically treated PAA patients at a single center.Methods Patients with PAA who underwent surgical treatment at the Department of Vascular Surgery, the Second Xiangya Hospital of Central South University between January 2018 and December 2024 were retrospectively reviewed. Baseline characteristics, operative details, perioperative outcomes, and follow-up data were collected. Limb salvage, primary patency, and secondary patency were estimated using Kaplan-Meier analysis. Primary patency was further compared between great saphenous vein grafts and prosthetic grafts.Results A total of 26 patients involving 30 limbs were included. The cohort comprised 18 men (69.2%) with a mean age of (59.2±14.2) years. Bilateral lesions were identified in 6 patients (23.1%), and concomitant aortic or iliac aneurysms were present in 6 patients (23.1%). Twenty-four limbs (80.0%) had true aneurysms, and six (20.0%) had pseudoaneurysms. Open surgical repair was performed in 28 limbs (93.3%), whereas endovascular repair was performed in 2 limbs (6.7%). Open procedures included prosthetic graft reconstruction in 16 limbs (53.3%), great saphenous vein grafting in 6 (20.0%), end-to-end anastomosis in 5 (16.7%), and arterial repair in 1 (3.3%). The 30-day complication rate was 10.0%, and no perioperative deaths occurred. The median follow-up duration was 60.0 (19.5-81.3) months. Limb salvage rates were 100.0% at 6 months, 1 year, and 3 years, and 93.8% at 5 years. Primary patency rates were 92.8%, 92.8%, 92.8%, and 86.7%, while secondary patency rates were 96.2%, 96.2%, 96.2%, and 89.3%, respectively. The 6-year primary patency rate was 100.0% in the great saphenous vein group and 53.1% in the prosthetic graft group, without a statistically significant difference (P=0.208).Conclusion Patients with PAA demonstrate a substantial prevalence of bilateral disease and concomitant aortic aneurysmal disease, highlighting the importance of comprehensive vascular screening. Open repair remains safe and effective, and autologous great saphenous vein grafts should be preferred whenever feasible. Endovascular repair may serve as an alternative option in selected patients, although further studies are required to clarify its long-term durability.