10.1177/1056789514562152

Vollständiger Abstract

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<h4>Introduction</h4>Endovascular repair has increasingly been adopted as a less-invasive alternative to open surgery for popliteal artery aneurysms, yet its long-term durability remains debated. Since the last comprehensive review in 2015, substantial new data with extended follow-up have emerged. This systematic review aimed to evaluate long-term outcomes after endovascular popliteal artery aneurysm repair (EPAR) and summarise contemporary evidence published between 2014 and 2025.<h4>Methods</h4>In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Web of Science, and Scopus were searched from January 2014 to November 2025. Studies including ≥10 adult patients undergoing EPAR with covered stent grafts and reporting follow-up of ≥3 years were eligible. Pooled Kaplan-Meier estimates were generated for long-term primary patency (primary outcome), as well as secondary patency, primary-assisted patency, overall survival, and freedom from reintervention where reported. Risk of bias was assessed using ROBINS-I (Risk Of Bias In Nonrandomized Studies of Interventions), and certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).<h4>Results</h4>Eleven retrospective cohort studies were included, comprising 929 patients and 993 treated limbs. The weighted mean age was 72.8 years, and 95.8% of patients were male. Bilateral disease was present in 24.5% of patients, and 28.9% were symptomatic at presentation. Endovascular repair was associated with high technical success (>98%) and low perioperative morbidity. Pooled Kaplan-Meier estimates for primary patency at 1, 3, 5, 10, and 15 years were 84.5%, 72.1%, 64.4%, 51.2%, and 47.3%, respectively. At 15 years, secondary patency and primary-assisted patency were 59.5% and 46.7%, respectively, while overall survival was 35.5%. Freedom from reintervention was 74.3% at 5 years. All studies were judged to be at serious risk of bias, and certainty of evidence was very low for all outcomes.<h4>Conclusion</h4>EPAR is a feasible and safe option for popliteal artery aneurysms, providing good midterm patency with acceptable survival and reintervention rates in appropriately selected patients. Patency declines beyond 10 years; however, interpretation is limited by retrospective study design, low certainty of evidence, small number of studies with extended follow-up, and the use of earlier-generation devices and techniques. Therefore, prospective studies with standardised long-term outcome reports are needed.Clinical ImpactThis updated long-term analysis demonstrates that endovascular popliteal artery aneurysm repair (EVPAR) provides acceptable durability, with sustained secondary patency and limb preservation up to 15 years. Although primary patency declines over time, reinterventions effectively maintain graft function in selected patients. These findings reinforce EVPAR as a viable option in appropriately selected individuals, particularly those at high surgical risk or with favorable anatomy. Importantly, the study highlights the need for structured long-term surveillance and careful patient selection to optimize outcomes. Clinicians should balance minimally invasive benefits against the risk of late occlusion and tailor follow-up strategies accordingly.

Abstract: PubMed · Datensatz