Deciphering Popliteal Artery Aneurysm Patient Diversity: Insights From a Cluster Analysis of the POPART Registry
Authors: Leinweber Maria Elisabeth , Schmandra Thomas , Karl Thomas , Torsello Giovanni , Böckler Dittmar , Walensi Mikolaj , Geisbuesch Phillip , Schmitz‐Rixen Thomas , Jung Georg , Hofmann Amun Georg , Surgery Endovascular , Storck Martin , Surgery Thoracic , Balzer Kai , Surgery Endovascular , Kugelmann Ulrich , Surgery Endovascular , Schneider Christina , Surgery Vascular , Engelhardt Michael , Surgery Endovascular , Petzold Michael , Weis‐Mueller Barbara , Hilf Kliniken Maria , Wortmann Markus , Surgery Transplantation , Popp Sebastian , Surgery Endovascular , Grotemeyer Dirk , Wenk Heiner , Shayesteh‐Kheslat Roushanak , Surgery Pediatric , Torsello Giovanni , Meisenbacher Katrin , Surgery Endovascular , Hoffmann Johannes , Schelzig Hubert , Surgery Endovascular , Roopa Yush , Surgery Endovascular , Strohschneider Thomas , Surgery Endovascular , Noppeney Thomas , Reichert Viktor , Surgery Endovascular , Lorenz Uwe , Pfister Karin , Damirchi Shoaeddin , Stojanovic Tomislav , Surgery Endovascular , Oberhuber Alexander , Surgery Endovascular , Lobenstein Bernd , Sagban Tolga Atilla , Pfeiffer Tomas , Surgery Endovascular , Koller Johann , Surgery Endovascular , Sprenger Christian , Surgery Endovascular , Kruschwitz Thomas , Marquardt Frank , Schmandra Thomas , Surgery Endovascular , Bail Dorothee 
Published: June 2024

Background
Popliteal artery aneurysms (PAAs) are the most common peripheral aneurysm. However, due to its rarity, the cumulative body of evidence regarding patient patterns, treatment strategies, and perioperative outcomes is limited. This analysis aims to investigate distinct phenotypical patient profiles and associated treatment and outcomes in patients with a PAA by performing an unsupervised clustering analysis of the POPART (Practice of Popliteal Artery Aneurysm Repair and Therapy) registry.

Methods and Results
A cluster analysis (using k‐means clustering) was performed on data obtained from the multicenter POPART registry (42 centers from Germany and Luxembourg). Sensitivity analyses were conducted to explore validity and stability. Using 2 clusters, patients were primarily separated by the absence or presence of clinical symptoms. Within the cluster of symptomatic patients, the main difference between patients with acute limb ischemia presentation and nonemergency symptomatic patients was PAA diameter. When using 6 clusters, patients were primarily grouped by comorbidities, with patients with acute limb ischemia forming a separate cluster. Despite markedly different risk profiles, perioperative complication rates appeared to be positively associated with the proportion of emergency patients. However, clusters with a higher proportion of patients having any symptoms before treatment experienced a lower rate of perioperative complications.

Conclusions
The conducted analyses revealed both an insight to the public health reality of PAA care as well as patients with PAA at elevated risk for adverse outcomes. This analysis suggests that the preoperative clinic is a far more crucial adjunct to the patient's preoperative risk assessment than the patient's epidemiological profile by itself.