Abstract：
BACKGROUND: Popliteal artery aneurysms (PAA) were traditionally treated by open repair (OR). Endovascular repair (ER) has become a new treatment strategy. The aim of this systemic review and meta-analysis was to evaluate and compare the current outcomes of OR and ER in the emergency treatment of PAA.
METHODS: A systematic literature search of the PubMed/Medline database was carried out. Outcomes were 30-day mortality, morbidity, major amputation rate (30 days), major amputation rate (1 year), 1-year primary patency rate, 1-year secondary patency rate and 1-year survival. Additionally, we included clinical data of patients with popliteal aneurysms treated between 2009 and 2021 at the Martin-Luther University Halle-Wittenberg.
RESULTS: We identified two cohort studies from 2014 and 2015 with a total of 199 patients that underwent emergent surgery (39 ER and 160 OR). We also included 26 patients from our institution. For emergency treatment, 30-day major amputation rates (18% vs 3%, Odds Ratio 5.82, 95% CI [1.75; 19.30], p = .004), 30-day mortality rates (10% vs 1%, Odds Ratio 5.57, 95% CI [1.01; 30.58], p = .05), 1-year major amputation rates (15% vs 6% Odds Ratio 3.61, 95% CI [1.18; 11.09], p = .02), 1-year loss of primary patency (54% vs 23%, Odds Ratio 3.19, 95% CI [0.91; 11.20], p = .07), and 1-year loss of secondary patency (44% vs 12%, Odds Ratio 6.91, 95% CI [3.01; 15.83], p < .05) were higher in the ER group when compared to the OR group.
CONCLUSIONS: Endovascular repair represents an alternative approach for the emergency treatment of PAA. Limited evidence from the available non-randomized studies shows unfavorable outcomes for patients undergoing ER. However, the results are prone to selection bias, and only randomized trials comparing ER to OR might reveal whether a subgroup of patients would benefit from ER as primary treatment of PAA in an emergency setting.
METHODS: A systematic literature search of the PubMed/Medline database was carried out. Outcomes were 30-day mortality, morbidity, major amputation rate (30 days), major amputation rate (1 year), 1-year primary patency rate, 1-year secondary patency rate and 1-year survival. Additionally, we included clinical data of patients with popliteal aneurysms treated between 2009 and 2021 at the Martin-Luther University Halle-Wittenberg.
RESULTS: We identified two cohort studies from 2014 and 2015 with a total of 199 patients that underwent emergent surgery (39 ER and 160 OR). We also included 26 patients from our institution. For emergency treatment, 30-day major amputation rates (18% vs 3%, Odds Ratio 5.82, 95% CI [1.75; 19.30], p = .004), 30-day mortality rates (10% vs 1%, Odds Ratio 5.57, 95% CI [1.01; 30.58], p = .05), 1-year major amputation rates (15% vs 6% Odds Ratio 3.61, 95% CI [1.18; 11.09], p = .02), 1-year loss of primary patency (54% vs 23%, Odds Ratio 3.19, 95% CI [0.91; 11.20], p = .07), and 1-year loss of secondary patency (44% vs 12%, Odds Ratio 6.91, 95% CI [3.01; 15.83], p < .05) were higher in the ER group when compared to the OR group.
CONCLUSIONS: Endovascular repair represents an alternative approach for the emergency treatment of PAA. Limited evidence from the available non-randomized studies shows unfavorable outcomes for patients undergoing ER. However, the results are prone to selection bias, and only randomized trials comparing ER to OR might reveal whether a subgroup of patients would benefit from ER as primary treatment of PAA in an emergency setting.
摘要：
背景：传统上通过开放修复（OR）治疗p动脉瘤（PAA）。血管内修复(ER)已成为一种新的医治战略。本系统综述和荟萃分析的目的是评估和比较OR和ER在PAA急诊治疗中的当前结果。
方法：对PubMed/Medline数据库进行了系统的文献检索。结果是30天死亡率，发病率，主要截肢率（30天），主要截肢率（1年），1年主要通畅率，1年二次通畅率和1年生存率。此外,我们纳入了2009年至2021年在Martin-LutherUniversityHalle-Wittenberg接受治疗的pop动脉瘤患者的临床数据.
结果：我们从2014年和2015年确定了两项队列研究，共有199例患者接受了紧急手术（39ER和160OR）。我们还包括来自我们机构的26名患者。对于紧急治疗，30天大截肢率（18%对3%，赔率比5.82，95%CI[1.75；19.30]，p=.004)，30天死亡率（10%对1%，赔率比5.57，95%CI[1.01；30.58]，p=.05)，1年主要截肢率（15%vs6%赔率3.61，95%CI[1.18；11.09]，p=.02)，1年原发性通畅性丧失(54%vs23%，赔率比3.19，95%CI[0.91；11.20]，p=.07)，和1年二次通畅性损失(44%对12%，赔率比6.91，95%CI[3.01；15.83]，与OR组相比，ER组的p<0.05）更高。
结论：腔内修复术是PAA急诊治疗的一种替代方法。来自现有非随机研究的有限证据表明，接受ER的患者预后不良。然而,结果容易出现选择偏差，只有将ER与OR进行比较的随机试验才可能揭示,在急诊情况下,ER作为PAA的主要治疗方案是否会使患者亚组受益.
方法：对PubMed/Medline数据库进行了系统的文献检索。结果是30天死亡率，发病率，主要截肢率（30天），主要截肢率（1年），1年主要通畅率，1年二次通畅率和1年生存率。此外,我们纳入了2009年至2021年在Martin-LutherUniversityHalle-Wittenberg接受治疗的pop动脉瘤患者的临床数据.
结果：我们从2014年和2015年确定了两项队列研究，共有199例患者接受了紧急手术（39ER和160OR）。我们还包括来自我们机构的26名患者。对于紧急治疗，30天大截肢率（18%对3%，赔率比5.82，95%CI[1.75；19.30]，p=.004)，30天死亡率（10%对1%，赔率比5.57，95%CI[1.01；30.58]，p=.05)，1年主要截肢率（15%vs6%赔率3.61，95%CI[1.18；11.09]，p=.02)，1年原发性通畅性丧失(54%vs23%，赔率比3.19，95%CI[0.91；11.20]，p=.07)，和1年二次通畅性损失(44%对12%，赔率比6.91，95%CI[3.01；15.83]，与OR组相比，ER组的p<0.05）更高。
结论：腔内修复术是PAA急诊治疗的一种替代方法。来自现有非随机研究的有限证据表明，接受ER的患者预后不良。然而,结果容易出现选择偏差，只有将ER与OR进行比较的随机试验才可能揭示,在急诊情况下,ER作为PAA的主要治疗方案是否会使患者亚组受益.
