Contemporary Management of Popliteal Artery Aneurysms: A Comprehensive Review

<i>Background and Objectives</i>: current guidelines recommend surgical treatment for asymptomatic popliteal artery aneurysm > 20 mm in diameter, although without any suggestion about the preferred treatment choice. The two main treatment options are open surgical repair (OPAR) and endovascular repair (EPAR). Although ER has emerged as a promising technique due to being less invasive, OPAR remains the standard in many centers. The aim of the study is to report and compare outcomes of both endovascular and open repair of asymptomatic PAAs to provide an extensive overview of their current management. <i>Materials and Methods</i>: the present review was conducted in accordance with the Preferred Reporting Items for Review and Meta-Analyses (PRISMA) Guidelines. Preliminary searches were conducted on MEDLINE, Pubmed, Scopus, and Web of Science from January 2010 to September 2025. Articles were divided into three main groups based on the preferred treatment modality. Early outcomes were technical success, mortality, major adverse cardiovascular events (MACEs), and graft occlusion(s). In mid- and long-term periods, the evaluated outcomes were overall survival, amputation-free survival, primary patency, primary assisted patency, secondary patency, and freedom from reintervention. <i>Results</i>: 21 articles were identified for a total of 9760 patients and 10,062 limbs treated. Technical success was up to 100% for both OPAR and EPAR with low complication rates. Primary patency (79.8% vs. 63.8%; <i>p</i> = 0.012) and freedom from reintervention (82.2% vs. 68.4%; <i>p</i> = 0.021) seem to be better for OPAR than EPAR. Overall survival, amputation free-survival, and secondary patency rates are comparable between the two techniques. <i>Conclusions</i>: although endovascular repair has emerged as a safe and effective approach to treat elective PAAs, long-term data on a large scale are still lacking. Indeed, open surgical repair remains the milestone, due to excellent primary patency rates, regardless of the conduit used.