Endovascular versus open repair for popliteal aneurysm: a review on limb salvage and reintervention rates

Abstract

Open repair remains the gold standard technique for popliteal aneurysm repair. However, the endovascular approach has gained increased popularity. Comparison between these techniques remain crucial to aid the physician choice, yet, data on mid-term outcomes lack in the literature. The present review aims to compare the limb salvage and reintervention rates in these different approaches. A comprehensive literature review was conducted to identify publications on endovascular treatment or open repair of popliteal artery aneurysms (PAAs). Primary endpoints were reintervention and limb salvage. Twenty-seven studies were selected for analysis describing a total of 5425 patients: 1651 PAAs underwent endovascular repair and 4166 PAAs were treated with open surgery. The technical success rates varied between 83.3% to 100% in the endovascular group and 79% to 100% in the open repair. For endovascular repair, the limb salvage at 1 year ranged between 84.2% and 100%, at 3 years between 88.9% and 100%; and at 5 years between 64.7% and 100%. The reintervention rate at 1 year ranged between 3.7% and 21%, at 3 years between 18.9% and 28%, and at 5 years between 34.5% and 38%. For open repair, the limb salvage varied between 94.3% and 100% at 1 year, 94.5% and 99% at 3 years, and 86.4% to 97% at 5 years. Regarding the reintervention rate, at 1 year was 12.8% and 13%, at 3 years 3.6% and 12%, and at 5 years varied between 15.7% and 30%. Both endovascular and open repair of popliteal aneurysms represent safe options for popliteal aneurysm repair. Yet, on mid-term, open repair is associated with greater limb salvage and fewer reintervention rates. Still, further studies are needed to access the long-term durability of this technique and its suitability in emergency settings.