Systematic review and reconstructed individual patient data of atherosclerotic subclavian artery aneurysm in the endovascular era

Objective: To summarize incidence, presentation, management and outcomes of true isolated atherosclerotic subclavian artery aneurysms (SAAs) in the endovascular era using reconstructed individual patient data. Methods: Medline and Embase were searched (1993-2025). Primary outcome was 30-day complications; secondary outcomes included follow-up (FU) events and aneurysm characteristics. Results: Sixty-seven SAAs in 66 patients were included. Symptoms occurred in 56%, mainly compression, haemoptysis or embolization; rupture occurred in 22%. Open, endovascular and hybrid repair were performed in 34%, 46% and 20%, respectively. Thirty-day complications occurred in 9%, without differences among strategies. During 12-month median FU, late complications were comparable. Aneurysm diameter, side and location were not associated with symptoms. Conclusions: Atherosclerotic SAAs are rare and frequently symptomatic. Repair should not rely on diameter alone. Open, endovascular and hybrid approaches are safe.