Popliteal artery aneurysms represent the most common peripheral arterial aneurysm. The optimal treatment strategy for popliteal artery aneurysms remains controversial. This study aimed to systematically evaluate and compare the clinical outcomes of endovascular versus open surgical repair of popliteal artery aneurysms. MEDLINE, EMBASE REVIEW METHODS: A systematic review and meta-analysis were conducted following the PRISMA guidelines (PROSPERO registration number CRD420251011632). Risk of bias was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool, and evidence certainty was evaluated using the GRADE approach. Primary outcomes included primary and secondary patency rates and freedom from reintervention. Nineteen studies, including 13 473 limbs (2 989 endovascular, 10 484 open), met the eligibility criteria. Open repair was associated with higher primary patency (HR 1.92, 95% CI 1.26 - 2.94, p = .003) and secondary patency (HR 1.60, 95% CI 1.04 - 2.44, p = .030) compared with endovascular repair. Freedom from reintervention also favoured open repair (HR 1.84, 95% CI 1.26 - 2.67, p = .001), whereas overall survival, freedom from amputation, and 30 day/in hospital mortality did not differ significantly between techniques. Endovascular repair resulted in a shorter hospital stay (mean difference -3.25, 95% CI -4.05 - 2.45, p < .001). Subgroup analyses showed that autologous vein bypass had superior primary patency versus endovascular repair (HR 2.37, 95% CI 1.45 - 3.88; p < .001), whereas prosthetic grafts did not differ significantly (HR 1.28, 95% CI 0.76 - 2.15; p = .35). The overall certainty of evidence for the primary outcomes was rated very low. Open surgical repair of popliteal artery aneurysms offers superior primary and secondary patency and should be the preferred treatment option in patients with acceptable operative risk. Endovascular repair may offer an alternative with a shorter hospital stay but carries a higher rate of reintervention.

Background/Objectives: The aim of this study was to assess whether preoperative pulmonary function testing (PFT) is related to postoperative complications after open thoracoabdominal aortic aneurysm (TAAA) repair. Methods: This study was conducted as a retrospective cohort analysis of 205 patients undergoing open TAAA repair (2006–2024) with preoperative spirometry and body plethysmography with at least one value available. Patients were classified by ventilation patterns: obstructive (n = 85, 45.2%), restrictive (n = 26, 14.1%), and hyperinflation (n = 56, 30.3%). Primary endpoints included in-hospital mortality, pulmonary complications (pneumonia, ARDS), and multi-organ outcomes. Associations were analyzed using chi-square and Spearman correlation tests and multivariable linear regression adjusted for age, smoking status, COPD, emergency operation, and time period. Results: Postoperative pulmonary complications occurred in 126 patients (61.5%), including pneumonia (46.8%) and ARDS (15.1%). Reduced vital capacity and FEV₁ expressed as a percentage of the lower limit of normal (%LLN) were related to postoperative pneumonia (p = 0.031 and p = 0.003) and ARDS (p = 0.038). Both obstructive and restrictive ventilation patterns were related to acute kidney injury after surgery (all KDIGO stage) (p = 0.044 and p = 0.043, respectively). Hyperinflation was related to atrial fibrillation (p = 0.039) and stroke (p = 0.034). FEV₁ < 2.0 L was related to increased mortality risk (p = 0.037), and FEV₁ < 1.5 L predicted acute kidney injury (p = 0.017), spinal cord ischemia (p = 0.035), and mortality (p = 0.023). Prolonged mechanical ventilation correlated with reduced preoperative lung function (VC %LLN ρ = −0.288, p = 0.002; FEV₁ %LLN ρ = −0.286, p = 0.001). During median follow-up of 6.35 years, patients in the highest FEV₁ quartile demonstrated substantially reduced long-term mortality (HR 0.27, 95% CI 0.10–0.73, p = 0.01). These associations between lower FEV₁ and VC (expressed as %LLN) with pneumonia, ARDS, in-hospital mortality, and prolonged ventilation remained significant after multivariable analysis. Conclusions: Preoperative pulmonary function assessment may help identify TAAA patients at increased risk of postoperative complications and mortality. Combining percentage-predicted spirometry, ventilation patterns, and hyperinflation markers may support individualized treatment selection, prehabilitation, and perioperative monitoring based on each patient’s specific risk profile.

Background: To present perioperative and follow-up outcomes of physician-modified endograft (PMEG) repair for juxtarenal and pararenal abdominal aortic aneurysms. Methods: This PRISMA 2020 systematic review and single-arm meta-analysis was registered with PROSPERO (CRD420261340339). PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched until December 2025. Eligible reports described full-text-confirmed cohorts of at least five patients treated with PMEG. The strict primary analysis required endpoint-separable juxtarenal or pararenal populations and used random-effects generalized linear mixed models for pooled proportions. Methodological quality and evidence certainty were assessed using the Joanna Briggs Institute checklist and GRADE framework. Results: Fifteen eligible reports described 981 patients before overlap adjudication; 10 reports originated from one institution and contained overlapping populations. After pathology and endpoint-level overlap adjudication, one to four independent populations informed each endpoint estimate, and single-source outcomes were not pooled. Technical success was 97.8% (95% CI, 94.8–99.1%; three populations, 228 patients), and 30-day mortality was 2.3% (95% CI, 1.1–4.8%; four populations, 299 patients). Acute kidney injury, stroke, and spinal cord ischemia occurred in 4.5%, 1.6%, and 1.7% of patients, respectively. During available follow-up, the single-source Type III endoleak estimate was 3.4% (7/203), any reintervention was 13.2% (95% CI, 2.9–43.7%; two populations, 217 patients; I² = 89.0%), and patient-level target-vessel occlusion was 2.4% (95% CI, 0.6–9.1%; 2 populations, 83 patients). Follow-up estimates were exploratory report-period proportions. GRADE certainty was very low for all key outcomes. Conclusions: PMEG repair demonstrated a high technical-feasibility signal and low observed early event rates in experienced centers, but clinical effectiveness and durability remain uncertain. The evidence base is dominated by overlapping expert-center reports and should not be interpreted as establishing equivalence or superiority to custom-manufactured FEVAR.

Purpose: This study aims to assess whether perioperative microembolization can identify patients at risk for postoperative stroke. Methods: A total of 257 carotid endarterectomy procedures in 254 patients were analyzed (154 symptomatic, 103 asymptomatic). Neuromonitoring, combining transcranial Doppler ultrasonography and continuous electroencephalography, was utilized to evaluate cerebral perfusion and detect microembolic signals (MES). Monitoring covered the entire intraoperative phase and a standardized 20-minute postoperative observation window. Results: Postoperative stroke occurred in seven patients, six of whom were symptomatic prior to the procedure. In exploratory penalized regression analyses, higher postoperative MES counts (OR 1.02 per MES, 95% CI 1.01–1.04; p < 0.001) and an intraoperative burden of ≥ 10 MES (OR 6.06, 95% CI 1.40–34.78; p = 0.016) were associated with postoperative stroke. Symptomatic patients exhibited a significantly higher embolic burden (6.7 ± 13.3 vs. 2.2 ± 5.0, p = 0.004). Conclusion: Beyond its role in guiding selective shunting, transcranial Doppler monitors the occurrence of microembolization, which could serve as a potential indicator of perioperative stroke. In this exploratory analysis, both an intraoperative burden of 10 or more MES and sustained postoperative microembolization were associated with postoperative stroke. Given the low number of events, these findings are hypothesis-generating and require prospective validation before they can guide perioperative management.