Endovascular and Open Approaches to Non-thrombosed Popliteal Aneurysm Repair: A Meta-analysis

Objective Endovascular repair of popliteal artery aneurysms is a relatively new technique that is still undergoing evaluation. The aim of this study was to compare outcomes following open and endovascular approaches. Methods All published studies comparing outcomes following open and endovascular popliteal aneurysm were included. Endpoints included operative duration, length of stay, and postoperative complications including short-term patency rates. Outcomes were combined using a random-effects meta-analytical technique and differences assessed using odds ratios (OR), weighted mean difference (WMD) and log hazards ratio (HR). Results Three studies comprising 141 patients (37 endovascular; 104 open) were included. No significant differences in patient characteristics were seen. Operative duration was significantly longer for endovascular repair (WMD 120 minutes, p < 0.001). Thirty day graft thrombosis (OR 5.05, p = 0.06) and reintervention (OR 18.80, p = 0.03) were more likely following endovascular repairs. Postoperative length of stay was shorter in the endovascular group (WMD – 3.9 days, p < 0.001). There was no significant difference in long-term primary patency rates (HR 1.70, p = 0.53). Conclusions Endovascular repair of popliteal artery aneurysms offers similar medium-term benefits as an open repair. However, short-term graft thrombosis and reintervention rates are significantly greater. With the current technology it is difficult to justify endovascular treatment of popliteal aneurysms.