Systematic Review and Meta-Analysis of Endovascular Versus Open Repair of Popliteal Artery Aneurysms

OBJECTIVE: Popliteal artery aneurysms represent the most common peripheral arterial aneurysm. The optimal treatment strategy for popliteal artery aneurysms remains controversial. This study aimed to systematically evaluate and compare the clinical outcomes of endovascular vs. open surgical repair of popliteal artery aneurysms. DATA SOURCES: MEDLINE, EMBASE. REVIEW METHODS: A systematic review and meta-analysis were conducted following the PRISMA guidelines (PROSPERO registration number CRD420251011632). Risk of bias was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool, and evidence certainty was evaluated using the GRADE approach. Primary outcomes included primary and secondary patency rates and freedom from re-intervention. RESULTS: Nineteen studies, including 13 473 limbs (2 989 endovascular, 10 484 open), met the eligibility criteria. Open repair was associated with higher primary patency (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.26 - 2.94, p = .003) and secondary patency (HR 1.60, 95% CI 1.04 - 2.44, p = .030) compared with endovascular repair. Freedom from re-intervention also favoured open repair (HR 1.84, 95% CI 1.26 - 2.67, p = .001), whereas overall survival, freedom from amputation, and 30 day or in hospital mortality did not differ significantly between techniques. Endovascular repair resulted in a shorter hospital stay (mean difference -3.25, 95% CI -4.05 - 2.45, p < .001). Subgroup analyses showed that autologous vein bypass had superior primary patency compared with endovascular repair (HR 2.37, 95% CI 1.45 - 3.88, p < .001), whereas prosthetic grafts did not differ significantly (HR 1.28, 95% CI 0.76 - 2.15, p = .35). The overall certainty of evidence for the primary outcomes was rated very low. CONCLUSION: Open surgical repair of popliteal artery aneurysms offers superior primary and secondary patency and should be the preferred treatment option for patients with acceptable operative risk. Endovascular repair may offer an alternative with a shorter hospital stay but carries a higher rate of re-intervention.