Journal of vascular surgery | 2021
A Systematic Review and Meta-analysis of Treatment and Natural History of Popliteal Artery Aneurysms.
Abstract
OBJECTIVE\nTo summarize the best available evidence comparing open vs. endovascular popliteal artery aneurysm repair. We also summarized the natural history of popliteal artery aneurysms to support of the Society for Vascular Surgery guidelines.\n\n\nMETHODS\nWe searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with popliteal artery aneurysms treated with open vs endovascular approach. We also included studies of natural history of untreated patients. Studies were selected and appraised by pairs of independent reviewers. Meta-analysis was performed when appropriate.\n\n\nRESULTS\nWe identified 32 original studies and 4 systematic reviews out of 2,191 candidate references. Meta-analysis showed that compared with the endovascular approach, open surgical repair was associated with higher primary patency at 1 year [odds ratio 2.10 (95% CI, 1.41- 3.12)], lower occlusion rate at 30 days [odds ratio 0.41 (95% CI, 0.24- 0.68)] and fewer reinterventions [odds ratio, 0.28 (95%CI, 0.17-0.45)], but longer hospital stay [standardized mean difference 2.16 (95%CI, 1.23-3.09)] and more wound complications [odds ratio 5.18 (95%CI, 2.19-12.26)]. There was no statistically significant difference in primary patency at 3 years [odds ratio 1.38 (95% CI, 0.97- 1.97)], secondary patency [odds ratio 1.59 (95% CI, 0.84, 3.03)], mortality at the longest follow-up [odds ratio 0.49, (95%CI, 0.21-1.17], mortality at 30 days [odds ratio 0.28 (95%CI, 0.06-1.36)] or amputation [incidence rate ratio 0.85 (95%CI, 0.56-1.31)]. The certainty in these estimates was, in general, low. Studies of popliteal artery aneurysm natural history suggest that thromboembolic complications and amputation develop at a mean observation time of 18 months and they are frequent. At 5 years, approximately half of the patients had complications.\n\n\nCONCLUSION\nThis systematic review provides event rates for outcomes important to patients with popliteal artery aneurysms. Despite the low certainty of the evidence, these rates along with surgical expertise and anatomic feasibility can help patients and surgeons engage in shared-decision making.