title: Meta-analysis of posterior versus medial approach for popliteal artery aneurysm repair.
abstract: BACKGROUND
  Popliteal artery aneurysm is an uncommon vascular disease but one that can cause significant morbidity, the most severe being limb loss reported in 20% to 59% of cases. Two approaches to repair are described in the literature, the posterior and the medial; however, the "gold standard" method of repair remains controversial.
  
  
  METHODS
  A systematic review of electronic information sources was undertaken to identify papers comparing outcomes of posterior repair vs medial repair. The methodologic quality of the papers was assessed using the Newcastle-Ottawa Scale. Fixed-effect or random-effects models were applied to synthesize data.
  
  
  RESULTS
  The search yielded seven articles eligible for inclusion. The total population comprised 1427 patients; 338 had posterior repair and 1089 had medial repair. There was no difference in the two groups in terms of postoperative nerve damage (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.24-4.2) and 30-day postoperative complications (OR, 0.87; 95% CI, 0.43-1.77). Limb loss at 30 days occurred more frequently in the medial approach group, but the difference was not statistically significant (risk difference [RD], 0.02; 95% CI, -0.04 to 0.00). Thirty-day primary patency was not statistically different between groups (RD, -0.01; 95% CI, -0.04 to 0.02), but the 30-day secondary patency suggested superiority of the posterior approach (RD, 0.05; 95% CI, 0.02-0.07). Long-term primary and secondary patency both favored the posterior approach (OR, 1.61 [95% CI, 1.06-2.43] and OR, 1.73 [95% CI, 0.91-3.30], respectively). Aneurysm exclusion was also superior with the posterior approach (OR, 4.20; 95% CI, 1.40-12.60). The rate of reoperation favored the posterior approach (OR, 0.26; 95% CI, 0.09-0.72). Long-term risk of limb loss favored posterior repair, but no statistically significant difference was found (OR, 0.32; 95% CI, 0.43-1.77).
  
  
  CONCLUSIONS
  High-level comparative data comparing posterior and medial repair for popliteal artery aneurysms are not available. Within the parameters of this review, however, superiority of the posterior approach for primary and secondary patency, aneurysm exclusion, and need for reoperation was noted. High-level evidence from randomized clinical trials is required to define the relative benefits of the posterior approach over the medial approach in selected patients.
authors.affiliation: Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom. Electronic address: alisonphair@gmail.com.
authors.forename: Alison
authors.initials: A
authors.lastname: Phair
authors.affiliation: Department of General Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom.
authors.forename: Shahin
authors.initials: S
authors.lastname: Hajibandeh
authors.affiliation: Department of General Surgery, Queen's Medical Centre, Nottingham, United Kingdom.
authors.forename: Shahab
authors.initials: S
authors.lastname: Hajibandeh
authors.affiliation: Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: Damian
authors.initials: D
authors.lastname: Kelleher
authors.affiliation: Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: Riza
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency