Objective This study aims to assess the safety and viability of popliteal endarterectomy for isolated popliteal disease. Method The study is a retrospective review, single-institution review (2010–2020) which assessed all popliteal endarterectomies performed at a rural 180-bed teaching hospital. Cases were identified based on the CPT code. The decision for endarterectomy was based on favorable anatomy including focal disease limited to the popliteal artery able to be approached from a posterior approach. The electronic medical record was used to capture patient characteristics, procedural information, and follow-up data. Results A total of 14 patients underwent popliteal endarterectomy (8 males and 6 females). The mean age was 61.9 (range of 29–78). The average follow-up period was 33.3 months. The indications for surgery were claudication in five patients, rest pain in four patients, and tissue loss in five patients. The average ABI preoperatively was 0.66 (range of 0.31–0.94). The average ABI postoperatively was 0.98 (range of 0.58–1.62), with an average change of +0.30 (range of −0.25 to +0.7). Complications included one seroma, one superficial wound infection, one early thrombosis requiring subsequent bypass, and one deep venous thrombosis. Two patients required angioplasty during follow-up for treatment of stenosis in order to maintain patency. The primary patency rate was 92.3% at discharge. At 23 months, the primary patency rate was 78% and the primary-assisted patency rate was 89%. All patients treated for claudication had resolution of symptoms. For patients treated for critical limb ischemia, all patients had resolution of rest pain and all wounds healed by 24 months. Conclusion In carefully selected patients, popliteal endarterectomy is a durable open surgical alternative to bypass, which preserves vein conduits with short operative times, low complication rates, and excellent long-term patency.

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