Management Strategies for Popliteal Artery Aneurysms: A Systematic Review

Background: Popliteal Artery Aneurysms (PAAs) are the most common peripheral arterial aneurysms and pose a significant risk for limb-threatening complications such as thrombosis and embolization. Treatment options include open surgical repair and endovascular techniques, but optimal management remains debated, especially for asymptomatic cases. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Databases including PubMed, Embase, and Cochrane Library were searched from January 2000 to June 2025 for studies evaluating outcomes of PAA management. Keywords included “popliteal artery aneurysm,” “endovascular repair,” “open surgery,” and “outcomes.” Twelve articles met the inclusion criteria. Results: Twelve studies encompassing 1,128 patients were included. Open repair was associated with lower reintervention rates and superior long-term patency, while endovascular repair demonstrated lower perioperative morbidity and shorter hospital stays. For asymptomatic PAAs, surveillance is an emerging option in select patients with small aneurysms (<2 cm), but evidence remains limited. Symptomatic and large PAAs (>2 cm) generally warrant intervention. Limb salvage and aneurysm exclusion rates were similar between techniques when anatomically feasible. Conclusions: Both open and endovascular approaches are effective for PAA management, each with distinct advantages. Patient selection based on anatomy, comorbidities, and symptomatology is critical. Further prospective trials are needed to refine indications, particularly for asymptomatic patients