Two Decades of Endovascular Repair of Popliteal Artery Aneurysm A Meta-analysis

WHAT THIS PAPER ADDS The evidence on the comparison of endovascular repair with open surgical repair of popliteal artery aneurysms remains inconclusive. Here, findings from the largest meta-analysis on this topic to date, based on 652 cases, are reported. The results suggest that patient outcomes after endovascular repair may be equal to open surgical repair, and the endovascular technique appears to be a viable alternative to open surgery. Nevertheless, current evidence on endovascular repair is limited and further research is necessary. Objective/Background: Over the last two decades endovascular repair (EVR) of popliteal artery aneurysms has emerged as a treatment alternative to conventional open surgical repair (OSR). The aim of this review was to evaluate the safety and efficiency of each repair method, comparing the following outcomes after EVR and OSR: (i) primary patency; (ii) operating time; (iii) length of hospital stay; (iv) pen-operative complications; (v) limb salvage; and (vi) patient survival. Methods: The PubMed and Cochrane Central Register of Controlled Trials were searched for publications that compared outcomes after EVR and OSR (last search November 2014). Randomized controlled trials (RCTs), prospective and retrospective observational cohort studies were included. The quality of studies was evaluated using the Newcastle Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Random effect models were employed to estimate odds ratios (ORs), mean differences, and hazard ratios (HRs). Results: One RCT combined with a prospective cohort study and four retrospective cohort studies with an overall total of 652 cases (236 EVR, 416 OSR) were identified. GRADE quality of evidence was low or very low for all outcomes. After a median follow up of 33 months, patients who received EVR showed equal primary patency rates to patients who received OSR (HR 1.46, 95% confidence interval [Cl] 0.92-2.33). Lengths of operation and hospitalization were significantly shorter following EVR; rates of 30 day graft thrombosis (OR 3.16, 95% Cl 1.31 7.62) and 30 day re-intervention (OR 2.15, 95% Cl 1.02-4.55) were significant higher for patients who received EVR compared with those who received OSR. There was no effect on mortality (OR 2.31, 95% Cl 0.37-14.49) or limb loss (OR 0.59, 95% Cl 0.16-2.15). Conclusion: EVR of popliteal artery aneurysm showed mid-term results comparable to open surgery and appears to be a safe alternative to OSR. However, the existing empirical evidence base is too fragmentary to draw firm conclusions. Further research and the introduction of population based registries will be needed to allow reliable evaluation of EVR. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.