Popliteal artery aneurysm treatment is more than open vs endovascular repair: outcome depends on conduit, approach, runoff, thrombus burden, acuity, and sex-specific risk. The full SAIMSARA evidence map gives humans and AI agents a structured, reference-linked view of 188 original studies and the key treatment signals.
Human-verified editorial review
Verified by World ID proof-of-human. This editorial layer was submitted from a SAIMSARA account verified as a unique human.
Abstract: The aim of this review is to synthesize current evidence regarding the treatment strategies for popliteal artery aneurysms, comparing the clinical outcomes of open surgical and endovascular interventions, and identifying key prognostic factors across diverse patient populations. The review utilises 188 original studies with 29285 total participants (topic deduplicated ΣN). The mapped evidence indicates that open surgical repair, particularly with autologous saphenous vein and a posterior approach, remains the dominant durable option for popliteal artery aneurysm, with 5-year primary patency reaching 81% versus 64.1% for endovascular repair and 12-month patency of 83.2% versus 44.7% in registry data. Endovascular repair was repeatedly associated with shorter hospitalization and faster recovery but with higher reintervention, falling primary patency from 69.1% at 6 months to 42.6% at 24 months in one cohort, and device-specific concerns at the popliteal hinge point. Recurrent signals across topics support early elective intervention for aneurysms exceeding 20 mm, adjunctive thrombolysis in acute ischemia, and morphology-based risk stratification using intraluminal thrombus volume rather than diameter alone, while sex-specific disparities including a threefold higher amputation risk in symptomatic women highlight an unresolved equity gap. Clinically, these signals suggest that conduit choice, surgical approach, and patient selection remain more influential than modality alone, and that endovascular repair is best reserved for anatomically eligible or high-risk patients under strict surveillance. Given the heterogeneity in diagnostic criteria and the predominance of retrospective evidence, future research should prioritize prospective comparative trials of next-generation hinge-point–tolerant stent-grafts, sex-specific intervention thresholds, and thrombus-volume–guided treatment algorithms to clarify durability and equity of care.
Final search date and database lock: 2026-05-02 20:38:43 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 455
Downloaded Abstracts/Papers: 455
Included original and non-original Abstracts/Papers (all): 209
Included original Abstracts/Papers (Vote counting by direction of effect): 188
Reference Index (links used in paper): 107
Total participants (topic deduplicated ΣN): 29285
Get access to the full paper
Unlock the full evidence map
The full evidence review, including the Introduction, Methods, Results, Discussion, Conclusion, figures, and complete reference index, opens after purchase or sign-in.
The Evidence Object JSON is a separate machine-readable evidence product: a concentrated synthesis of results, topic-level evidence, and discussion across original and non-original studies. It can be directly input into your LLM, agent, or RAG workflow.
[12] Deciphering Popliteal Artery Aneurysm Patient Diversity: Insights From a Cluster Analysis of the POPART Registry. — https://doi.org/10.1161/jaha.124.034429
[26] Observational study of endoluminal mural thrombotic apposition in popliteal artery aneurysm stenting and its relationship with stent-graft geometrical features. — https://doi.org/10.3389/fcvm.2023.1176455
[33] Effect of Intra-operative Intra-arterial Thrombolysis on Long Term Clinical Outcomes in Patients with Acute Popliteal Artery Aneurysm Thrombosis. — https://doi.org/10.1016/j.ejvs.2019.10.013
[39] [Treatment of Peripheral Aneurysms - Dual Supera for Popliteal Artery Aneurysms: Immediate and Long-Term Results]. — https://doi.org/10.1055/a-1059-9739
[40] External stenting and disease progression in vein grafts 1 year after open surgical repair of popliteal artery aneurysm. — https://doi.org/10.1016/j.jvs.2021.01.046
[44] Reliability of Ultrasound Diameter Measurements in Patients with a Small Asymptomatic Popliteal Artery Aneurysm: An Intra- and Inter-observer Agreement Study. — https://doi.org/10.1016/j.ejvs.2015.12.004
[51] Long-term outcome of endovascular repair of popliteal artery aneurysm presents a credible alternative to open surgery. — https://doi.org/10.1007/s00270-013-0744-6
[57] Ten years' experience in endovascular repair of popliteal artery aneurysm using the Viabahn endoprosthesis: a report from two Italian vascular centers. — https://doi.org/10.1016/j.avsg.2015.01.008
[58] Early complications and long-term outcome after open surgical treatment of popliteal artery aneurysms: is exclusion with saphenous vein bypass still the gold standard? — https://doi.org/10.1016/j.jvs.2006.12.011
[60] Great saphenous vein versus expanded polytetrafluoroethylene graft in patients undergoing elective treatment of popliteal artery aneurysm with a posterior approach. — https://doi.org/10.1016/j.jvs.2025.04.011
[69] Defining Popliteal Artery Aneurysm: A Systematic Review of the Morphological Assessment Used for Diagnosis and Treatment. — https://doi.org/10.1016/j.avsg.2025.06.012
[74] Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair. — https://doi.org/10.1177/17085381221126318
[83] A 54-Year-Old Man Who Developed a Femoral Pathologic Fracture from a Giant Popliteal Artery Pseudoaneurysm 7 Years After Ligation and Bypass of a Popliteal Artery Aneurysm: A Case Report and Literature Review. — https://doi.org/10.12659/ajcr.937113
[85] A Systematic Review and Meta-analysis of Endovascular Popliteal Aneurysm Repair Using the Hemobahn/Viabahn Stent-Graft. — https://doi.org/10.1177/1526602815579252
[97] Endovascular exclusion of popliteal artery aneurysms with expanded polytetrafluoroethylene stent-grafts: early results. — https://doi.org/10.1177/1538574406294366
[98] Early experience with the multilayer aneurysm repair stent in the endovascular treatment of trans/infragenicular popliteal artery aneurysms: a mixed bag. — https://doi.org/10.1583/12-4169r.1
[99] Open repair versus endovascular treatment for asymptomatic popliteal artery aneurysm: results of a prospective randomized study. — https://doi.org/10.1016/j.jvs.2005.04.049
[100] The thrombosed popliteal aneurysm with distal arterial occlusion--successful therapy by interdisciplinary management. — https://doi.org/10.1055/s-2007-1013782
[104] Contrast-enhanced ultrasound (CEUS) in the diagnostic evaluation of popliteal artery aneurysms, a single-center study. — https://doi.org/10.3233/ch-209214
[112] Female sex portends increased risk of major amputation following surgical repair of symptomatic popliteal artery aneurysms. — https://doi.org/10.1016/j.jvs.2022.03.892
[116] Outcome of popliteal artery aneurysms after exclusion and bypass: significance of residual patent branches mimicking type II endoleaks. — https://doi.org/10.1016/j.jvs.2004.08.029
[117] Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures. — https://doi.org/10.3390/jcm13102817
[123] Intraluminal thrombus volume correlates with the crural vessel runoff in popliteal artery aneurysms upon initial presentation. — https://doi.org/10.1024/0301-1526/a001198
[127] Open Versus Endovascular Repair of Patent Popliteal Artery Aneurysms in an Elective Setting: A Multicenter Retrospective Study with Long-Term Follow-Up. — https://doi.org/10.1016/j.avsg.2025.03.023
[137] Graft patency is not the only clinical predictor of success after exclusion and bypass of popliteal artery aneurysms. — https://doi.org/10.1067/mva.2003.30
[150] In-Stent Restenosis After Seven Years of Endovascular Surgery in a Case of Traumatic Popliteal Artery Pseudoaneurysm Following Total Knee Arthroplasty: A Case Report With Eight Years of Follow-Up. — https://doi.org/10.7759/cureus.90640
[182] Using vascular quality initiative as a platform for organizing multicenter, prospective, randomized clinical trials: OVERPAR trial. — https://doi.org/10.1016/j.avsg.2014.08.007
